When it comes to heart health among Medicare Advantage populations, social determinants of health (SDOH) play an important role. The World Health Organization defines SDOH as non-medical factors that account for as much as 55 percent of a person’s health outcomes.
Examples of SDOH include the circumstances in which people live, work, and age, as well as the systems put in place to provide healthcare and other services to a community. The impact of SDOH on chronic disease management can be significant. A recent study found that SDOH account for between 80 percent to 90 percent of the modifiable contributors to health outcomes for chronic diseases, such as heart failure.
The good news is that some SDOH can be addressed through various interventions which can decrease their impact on health outcomes.
Heart failure and SDOH: A bad combination for older Americans
Over 6.5 million Americans are diagnosed with heart failure and each year more than half a million more cases arise. Managing heart failure can be complex, even in the best of circumstances.
The first step in treating heart failure is arriving at a diagnosis, but SDOH can make traditional diagnostic pathways inaccessible, especially among older adults. To understand how SDOH impacts care, let’s consider Walter, a 79-year-old individual with diabetes who lives alone in a low-income neighborhood. He receives government assistance and stipends and often needs to decide between paying for food or medications. In addition, Walter routinely ignores or downplays clinical symptoms like chest pain and shortness of breath, which he’s been experiencing more frequently as he grows older. Walter has a son who lives nearby, however, his son works multiple jobs and does not have time to drive his father to multiple medical appointments in the middle of the week.
Historically, diagnosing heart failure requires multiple appointments and tests including blood draws, ECGs and ultrasounds, each associated with separate travel and cost. For Walter, it would be very difficult to find transportation to these appointments. And, any co-pays for these services would also pose a financial hardship.
The American Heart Association reports that heart failure patients, like Walter, who are food insecure, struggle with transportation, and have less access to medications and health services have significantly poorer health outcomes. This includes more frequent exacerbation of heart failure symptoms and potential repeated hospital admissions. All these issues are costly in terms of quality of life and cost of care.
Overcoming SDOH barriers with mobile technologies
To lower hurdles associated with heart failure diagnosis, new approaches are needed. Technological advances now make it possible to identify heart failure with noninvasive testing either at the point of care or in the home health care setting.
Ventric Health’s Vivio System™ evaluates the same gold standard hemodynamic definition of heart failure as catheter lab procedures – the measurement of elevated left ventricular filling pressures.1-4 That’s where the similarities end, however. Ventric Health’s breakthrough solution can be used in the home or primary care setting by a trained clinician, eliminating transportation barriers for older adults. A Vivio exam takes less than five minutes for a clinician to administer.
The portable nature of Vivio means that the site of care for diagnosing heart failure can be expanded, more patients can be identified earlier and treatment can begin sooner. As a result, older individuals with heart failure and SDOH can enjoy healthier days at home.
Incorporating technology solutions like Vivio into a holistic approach to wellness is particularly valuable for Medicare Advantage plans and at-risk organizations that serve members with SDOH, since high-cost utilization is more common among this population. Utilization and inpatient costs can be reduced through care management and patient education, reducing the total cost of care.
Conclusion
As the American Heart Association has observed, new technologies for monitoring heart failure can improve outcomes for all patients through early access to timely interventions and prevention of future exacerbations. Portable, noninvasive solutions like Ventric Health’s Vivio System delivers a new promise by aiding in heart failure diagnosis noninvasively in any care setting, reducing obstacles to care for older Americans dealing with SDOH. The result is more accessible and equitable care for individuals with heart failure.
Sources
- Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nature Reviews Cardiology. 2020;17:559573.
- Valentin Fuster RWA, Robert A. O'Rourke, Robert Roberts, Spencer B. King III, Eric N. Prystowsky, Ira S. Nash. Hurst's the Heart, 11th Edition: McGraw-Hill Professional Publishing; 2005.
- Pieske B, Tschöpe C, De Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M and Lam CS. How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European heart journal. 2019;40:3297-3317.
- McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J and Chioncel O. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2021;42:3599-3726.
