Social Vulnerability and Long-Term Cardiovascular Outcomes After COVID-19 Hospitalization: An Analysis of the American Heart Association COVID-19 Registry Linked With Medicare Claims Data.

Abstract

Background: Patients hospitalized with COVID-19 from socioeconomically vulnerable communities are at risk for in-hospital cardiovascular events. However, the association of socioeconomic vulnerability and outcomes after hospitalization is uncertain.

Methods and results: American Heart Association COVID-19 Cardiovascular Disease Registry hospitalizations between March 1, 2020, and June 30, 2022, linked with Medicare fee-for-service claims, were analyzed. We used Centers for Disease Control and Prevention's Social Vulnerability Index to ascertain county-level and Medicare-Medicaid dual eligibility to ascertain patient-level social vulnerability. We evaluated the association between social vulnerability and a composite of myocardial infarction, stroke, heart failure, venous thromboembolism, cardiogenic shock, cardiac arrest, and death, following discharge, using Cox regression models. The study included 8565 patients (mean age 78 years, 50% female, 16% Black, 4% Hispanic, 25% dual eligible, 34% residing in the most vulnerable counties). Patients residing in the most vulnerable counties, and dual eligible patients, were more likely to be female, Black or Hispanic, and have increased comorbidities. A total of 3783 (52%) patients experienced a composite outcome. We found no association between the most vulnerable, compared with least vulnerable, counties and cardiovascular events (hazard ratio [HR], 0.97 [95% CI, 0.87-1.07]). Dual eligibility, compared with nondual eligibility, was associated with increased cardiovascular events (HR, 1.28 [95% CI, 1.19-1.37]), which was attenuated after adjusting for comorbidities (HR, 0.97 [95% CI, 0.89-1.04]).

Conclusions: Among survivors of COVID-19 hospitalization, patient-level social vulnerability was associated with cardiovascular events, explained by increased comorbidities. County-level social vulnerability was not observed to be a risk for postdischarge events. Findings suggest targeting public health efforts toward dual eligible patients to mitigate poor outcomes.