Background:Factors determining referral for advanced heart failure (HF) evaluation are poorly studied. We studied the influence of socioeconomic aspects on the referral process in Denmark, which has a taxpayer-funded national health care system.Methods:We identified all patients aged 18 to 75 years with a first diagnosis of HF during 2010 to 2018. Hospitalized patients had to be discharged alive and were then followed for the outcome of undergoing a right heart catheterization (RHC) used as a surrogate marker of advanced HF work-up.Results:Of 36 637 newly diagnosed patients with HF, 680 (1.9%) underwent RHC during the follow-up period (median time to RHC of 280 days [interquartile range, 73–914]). Factors associated with a higher likelihood of RHC included the highest versus lowest household income quartile (HR, 1.56 [95% CI, 1.19–2.06]; P=0.001), being diagnosed with HF at a tertiary versus nontertiary hospital (HR, 1.68 [95% CI, 1.37–2.05]; P<0.001) and during a hospitalization versus outpatient visit (HR, 1.67 [95% CI, 1.42–1.95]; P<0.001). Level of education, occupational status, and distance to tertiary hospital were not independently associated with RHC. Older age, cancer, and a psychiatric diagnosis were independently associated with a decreased probability of RHC.Conclusions:Higher household income, HF diagnosis during hospitalization, and first admission at a tertiary hospital were associated with increased likelihood of subsequent referral for RHC independent of other demographic and clinical variables. Greater attention may be required to ensure timely referral for advanced HF therapies in lower income groups.

中文翻译：

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转诊晚期心力衰竭侵入性血流动力学评估的社会经济差异：一项全国队列研究

背景：对于决定转诊进行晚期心力衰竭（HF）评估的因素研究很少。我们研究了丹麦社会经济因素对转诊过程的影响，丹麦拥有纳税人资助的国家医疗保健系统。方法：我们确定了 2010 年至 2018 年期间首次诊断出心力衰竭的所有年龄在 18 岁至 75 岁之间的患者。存活出院，然后随访接受右心导管检查 (RHC) 的结果，该结果用作高级心力衰竭检查的替代标志。 结果：在 36 637 名新诊断的心力衰竭患者中，680 名 (1.9%) 接受了右心导管检查随访期间（RHC 的中位时间为 280 天 [四分位距，73-914]）。与 RHC 较高可能性相关的因素包括最高家庭收入四分位数与最低家庭收入四分位数（HR，1.56 [95% CI，1.19-2.06]；P = 0.001），在三级医院与非三级医院诊断为心力衰竭（HR，1.68 [95% CI，1.37-2.05]；P <0.001）以及住院与门诊就诊期间（HR，1.67 [95% CI，1.42]） –1.95]；P<0.001）。教育水平、职业状况和距三级医院的距离与 RHC 不独立相关。年龄较大、癌症和精神病学诊断与 RHC 概率降低独立相关。结论：较高的家庭收入、住院期间的心力衰竭诊断以及首次入院三级医院与随后转诊 RHC 的可能性增加相关，独立于其他因素人口统计和临床变量。可能需要更加关注以确保及时转诊低收入群体接受先进的心力衰竭治疗。