Association Between Built Environment and Heart Failure Progression in an Urban Retrospective Cohort Study
/Abstract
A cohort of 1287 HF patients with at least one ejection fraction (EF) measurements were identified using electronic health records (EHRs) at a major academic medical center in New York City (NYC). Patients’ routinely collected EHR data were analyzed in combination with public data on built environment capturing information on transportation, air quality, land use, and accessibility to identify risk factors associated with HF progression using mixed-effects models. In addition, subgroup analyses were conducted by cardiac function. The primary outcome was the change in cardiac function as measured by EF. Daily nitrogen dioxide (NO2) concentration in the air was associated with an increased odds of HF progression while controlling for previously reported HF risk factors including sex, comorbidities, medication usage, and neighborhood poverty rates. Subgroup analysis by cardiac function showed that HF progression among patients with initially normal EF was significantly associated with exposure to decreased distance to subway stops and increased distance to nearest parks. Significant associations between the built environment and HF progression were found among patients in a dense urban environment, with varying effects by cardiac function.
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