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Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full‐text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross‐sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence‐based interventions that can ameliorate significant HF morbidity and societal costs.

Introduction: Heart failure (HF) is an ongoing health concern that is expected to affect 9 million Americans by 2030. Growing research shows the association between non-clinical, social determinants of health (SDoH) and adverse outcomes (hospitalizations, high costs, and premature mortality). Providers must be able to identify SDoH risk factors to improve care delivery and patient outcomes. Aim: To summarize how SDoH risk factors have been included, defined, measured, and assessed in studies that examine outcomes in the HF care continuum. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a search of five databases was conducted for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH risk factors on outcomes among subjects with HF. Study quality was assessed using NIH’s quality assessment tools. Results: The search identified 1,209 unique records; 108 were selected for full-text review. In total, 59 articles including retrospective and prospective cohort, cross-sectional, and intervention studies met criteria for inclusion. The majority of studies examined readmissions and hospitalizations (k=36); mortality or survival (k=32); and success of medical devices and transplantation (k=8). SDoH risk factors most commonly evaluated were race/ethnicity; age; gender; SES; social support; and education or health literacy. Studies used a range of 1-9 SDoH (M = 3.6, SD = 2.2) as primary independent variables and 0-7 SDoH as controls (M = 2.4, SD = 2.1). The studies used multiple data sources, frequently EMR linked with national surveys, disease registries, and/or data from large national studies. Overall, the effects of the SDoH risk factors on HF outcomes were mixed, and these differences appeared to be related to heterogeneity of data sources and SDoH constructs employed across studies. Conclusions: Our systematic review suggests that the influence of SDoH on HF outcomes remains incompletely assessed in part due to both inconsistent measurement and absence of potentially relevant variables. More expansive, real-time SDoH data collection is required if HF interventions are to meaningfully impact value-based and patient-centered models of care.

The United States has one of the highest infant mortality rates among developed countries. When stratified by race, disparities are more evident: Black infant mortality rates are 2.5 times higher than non-Hispanic white infants. Structural, systemic racism is a contributing cause for these racial disparities. Multisector collaborations focused on a common agenda, often referred to as collective impact, have been used for infant mortality reduction interventions. In addition, community-based participatory approaches have been applied to incorporate those with lived experience related to adverse pregnancy outcomes. This article critically describes the transition of an infant mortality collective impact initiative from being led by a multisector organizational group to being community led over a 5-year period, 2015–2020. A 34-member community leaders group was developed and determined four priorities and corresponding strategies for the initiative. Findings show that community participatory approaches are a way to address racial equity for public health initiatives.