{"id":"45983","type":"article","url":"https://hartvaat.nl/2026/05/19/nyc-4h-cohort-sociale-problemen-verviervoudigen-sterfterisico-bij-hiv-patienten-/","title":"NYC 4H-cohort: sociale problemen verviervoudigen sterfterisico bij hiv-patiënten met hartfalen","title_en":"Multidimensional Social Adversity and Mortality in People With HIV Infection and Heart Failure: Insights From NYC Health + Hospitals HIV–Heart Failure Cohort","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.078897","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.078897","authors":[],"significance":7,"published":"2026-07-08","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"Cohort study of the NYC Health + Hospitals HIV-Heart Failure (NYC 4H) registry in 1,044 participants (62.9% male, mean age 61.6 years). At baseline, multidimensional social adversity (SA) was assessed by licensed clinical social workers across 5 domains: economic hardship, healthcare access barriers, unstable neighbourhood/housing, social support challenges, and psychobehavioural instability. 58% had at least one SA domain, most often psychobehavioural instability (n=438). During 3.8 years of follow-up, any SA exposure was associated with higher all-cause mortality (HR 4.32), cardiovascular mortality (HR 4.05), and infection-related mortality (HR 2.37). Domain-specific associations: social support challenges and psychobehavioural instability predicted CV mortality; economic hardship and social support predicted infection mortality. Patients with environmental instability, psychobehavioural instability, or social support challenges had 73%, 75%, and 44% higher 6-month rehospitalisation risk respectively. Multidimensional SA assessment can support domain-specific risk stratification in HIV + heart failure.","created":"2026-07-03T20:27:01Z","updated":"2026-07-04T19:27:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cohortstudie van het NYC Health + Hospitals HIV-Heart Failure (NYC 4H)-register bij 1.044 deelnemers (62,9% man, gemiddelde leeftijd 61,6 jaar). Bij baseline werd multidimensionale sociale tegenspoed (SA) door maatschappelijk werkers in 5 domeinen gemeten: economische problemen, beperkte zorgtoegang, instabiele leefomgeving/huisvesting, beperkt sociaal netwerk en psycho-gedragsmatige instabiliteit. 58% had ten minste één SA-domein, meest psycho-gedragsmatige instabiliteit (n=438). Tijdens 3,8 jaar follow-up was elke SA-blootstelling geassocieerd met hogere totale mortaliteit (HR 4,32), cardiovasculaire mortaliteit (HR 4,05) en infectie-gerelateerde mortaliteit (HR 2,37). Domein-specifieke verbanden: sociaal netwerk en psycho-gedragsmatige instabiliteit voorspelden CV-sterfte; economische problemen en sociaal netwerk voorspelden infectiesterfte. Patiënten met instabiele omgeving, psycho-gedragsmatige instabiliteit of beperkt netwerk hadden 73%, 75% respectievelijk 44% hoger risico op 6-maands heropname. De multidimensionale SA-beoordeling kan domein-specifieke risico-stratificatie ondersteunen bij hiv + hartfalen.","abstract_original":"BACKGROUND:Heart failure is an increasingly common comorbidity among people with HIV infection, complicating care and heightening the vulnerability of this population to social adversity (SA). However, the impact of different SA domains on outcomes in this population remains poorly understood.METHODS:We analyzed data on people with HIV infection and heart failure from the NYC 4H (NYC Health + Hospitals HIV–Heart Failure) cohort. Baseline multidimensional SA was assessed by licensed clinical social workers using standardized evaluations and grouped into 5 domains: economic hardship, health care access barriers, neighborhood or built environment instability, social support challenge, and psychobehavioral instability. We used multivariable adjusted Cox models to estimate hazard ratios (HRs) of all-cause, cardiovascular, and infection-related mortality and logistic regression to estimate odds ratios of 6-month rehospitalization risk.RESULTS:Among 1044 participants (62.9% male; mean age, 61.6 years), 601 (58%) reported at least 1 SA: economic hardship (n=130), limited health care access (n=155), unstable housing (n=129), social support challenge (n=179), or psychobehavioral instability (n=438). Over a mean follow-up of 3.8 years, exposure to any SA was associated with higher all-cause mortality (HR, 4.32 [95% CI, 3.03–6.14]), cardiovascular mortality (HR, 4.05 [95% CI, 2.17–6.83]), and infection-related mortality (HR, 2.37 [95% CI, 1.23–4.56]). Social support challenge (HR, 2.19 [95% CI, 1.35–3.55]) and psychobehavioral instability (HR, 1.96 [95% CI, 1.24–3.11]) were associated with higher cardiovascular mortality. Economic hardship (HR, 2.40 [95% CI, 1.22–4.70]) and social support challenge (HR, 3.09 [95% CI, 1.75–5.48]) were associated with higher infection-related mortality. Compared with patients without SA, those with environmental instability, psychobehavioral instability, or social support challenges had a 73% (adjusted odds ratio, 1.73 [95% CI, 1.15–2.06]), 75% (adjusted odds ratio, 1.75 [95% CI, 1.31–2.35]), and 44% (adjusted odds ratio, 1.44 [95% CI, 1.00-2.06]) higher risk of rehospitalization within 6 months, respectively.CONCLUSIONS:SA was significantly associated with mortality and rehospitalization among people with HIV infection and heart failure, with domain-specific pathways influencing specific outcomes. Multidimensional assessment of SA may offer a framework for domain-specific risk stratification in people with HIV infection and heart failure."}