April 30 (UPI) -- Poverty and poor or non-existent health insurance coverage can make the effects of heart failure worse, the American Heart Association said Thursday.
Two statements published in the AHA's peer-reviewed medical journal Circulation suggest heart failure treatment should take "social determinants of health" into consideration. These include a person's overall living environment as well as socio-economic status.
Patients with less or no insurance, who struggle with food, transportation or affording medications or don't have a safe place to exercise have worse heart failure outcomes, Dr. Connie White-Williams, senior director of Nursing Services and the Heart Failure Transitional Care Clinic at the University of Alabama at Birmingham Hospital, said in a statement.
"It's important that we ask patients about the life issues and challenges they may be facing," said White-Williams, who chaired the AHA committee that drafted the statements. "These issues have a direct impact on the patient's ability to adhere to any care plan."
Heart failure affects 6.5 million Americans, according to the AHA. It is a slow, progressive disease in which the heart does not pump blood effectively. Although there is no cure, people with heart failure can live full lives with medication, lifestyle changes and social support, the group said.
The county in which a person lives, as well as personal and social factors, might restrict the ability of people with heart failure to receive state-of-the-art care, White-Williams and researchers write in the statement "Addressing Social Determinants of Health in the Care of Patients with Heart Failure."
These factors can include insurance status, disability status, race, ethnicity and income inequality, with AHA recommending an inter-professional healthcare team works together to support patients and their families and caregivers.
This support should address the life challenges that impact prognosis, such as a living situation, access to caregivers, ability to pay for medications and understanding of medical information, they said.
"This is a model we should be working towards implementing whenever possible," White-Williams said, noting that many clinical practices don't have the resources to deal with such challenges.
"Recognizing the importance of social determinants of health is a critical first step toward getting health systems engaged in developing approaches to mitigate the many adverse consequences of these factors in different settings."
The other statement published Thursday, "Family Care-giving for Individuals with Heart Failure," suggests that caregivers for heart failure patients, who spend an average of 22 hours per week with patients, require more attention from health care providers than they get.
In addition to making sure that caregivers know how to deliver the required care, paying attention to the ability and mental health of these people is crucial to caring for heart failure patients.
Dr. Lisa Kitko, chair of the family care-giving writing committee, noted that it is important to assess caregiver capabilities. That includes their motivation to provide care, their physical, sensory, motor and cognitive ability to perform required tasks and their level of distress and depression.
This, she said, includes consideration of loss of income for unpaid caregivers and various physical and psychological risks.
"In our current system health care system, there is a lack of incentives for clinicians to evaluate caregiver needs and offer direct support," said Kitko, who is an associate professor and associate dean of graduate education at the Penn State University College of Nursing. "The largest barrier is the lack of payment and reimbursement mechanisms that would allow clinicians to provide direct support to caregivers."
