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Background: Despite considerable evidence concerning heart failure (HF) risk factors, there is scarce information about the effect and degree of control regarding socioeconomic and gender inequalities. Methods: Cohort study including HF patients >40 years of age attended in 53 primary health care centers in Barcelona (Spain). Socioeconomic status (SES) was determined by an aggregated deprivation index (MEDEA) according to the neighborhood of residence. Logistic multivariable regression was performed to analyze differences in cardiovascular risk factor control, stratifying by SES and sex. Results: A total of 8235 HF patients were included. Mean age was 78.1 (standard deviation 10.2) years, and 56.0% were women. The most prevalent cardiovascular risk factors were hypertension, diabetes, and dyslipidemia. Blood pressure was the worst controlled factor in both genders with the lowest SES (odds ratio [OR] 0.56 95% confidence interval [CI] 0.56–0.71) and (OR 0.52, 0.46–0.71), respectively. In women, a social gradient was observed for glycemic and body mass index control, which were worse in the most unfavorable socioeconomic position (OR 0.54, 95% CI 0.38–0.77), and (OR 0.45, 95% CI 0.32–0.64), respectively. Men presented worse control of blood pressure (OR 0.55, 95% CI 0.42–0.71) and smoking habit (OR 0.67, 95% CI 0.47–0.90) in the most deprived socioeconomic bracket. Conclusion: Patients with HF in the most disadvantaged socioeconomic levels presented the worst degree of control for cardiovascular risk factors, and this negative effect was stronger in women. [ABSTRACT FROM AUTHOR]

Aims The assumption that improved self-care in the setting of heart failure (HF) care necessarily translates into improvements in long-term mortality and/or hospitalization is not well established. We aimed to study the association between self-care and long-term mortality and other major adverse HF events (MAHFE). Methods and results We conducted an observational, prospective, cohort study of 1123 consecutive patients with chronic HF. The primary endpoint was all-cause mortality. We used the European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure global self-care (overall score) and three specific dimensions of self-care including autonomy-based adherence, consulting behaviour and provider-based adherence. After a mean follow-up of 3.3 years, all-cause death occurred in 487 patients (43%). In adjusted analysis, higher EHFScBS-9 scores (better self-care) at baseline were associated with lower risk of all-cause death [hazard ratio (HR) 0.993, 95% confidence interval (CI) (0.988–0.997), P -value = 0.002], cardiovascular (CV) death [HR 0.989, 95% CI (0.981–0.996), P -value = 0.003], HF hospitalization [HR 0.993, 95% CI (0.988–0.998), P -value = 0.005], and the combination of MAHFE [HR 0.995, 95% CI (0.991–0.999), P -value = 0.018]. Similarly, impaired global self-care [HR 1.589, 95% CI (1.201–2.127), P -value = 0.001], impaired autonomy-based adherence [HR 1.464, 95% CI (1.114–1.923), P -value = 0.006], and impaired consulting behaviour dimensions [HR 1.510, 95% CI (1.140–1.923), P -value = 0.006] were all associated with higher risk of all-cause mortality. Conclusion In this study, we have shown that worse self-care is an independent predictor of long-term mortality (both, all-cause and CV), HF hospitalization, and the combinations of these endpoints in patients with chronic HF. Important dimensions of self-care such as autonomy-based adherence and consulting behaviour also determine the risk of all these outcomes in the long term. [ABSTRACT FROM AUTHOR]