Correction to: “Socioeconomic Disparities in Referral for Invasive Hemodynamic Evaluation for Advanced Heart Failure: A Nationwide Cohort Study”
In the article by Larsson et al, “Socioeconomic Disparities in Referral for Invasive Hemodynamic Evaluation for Advanced Heart Failure: A Nationwide Cohort Study,” which published online on August 31, 2021 and appeared in the October 2021 issue of the journal (Circ Heart Fail.2021;14: e008662), a correction is needed.
The error affects the data reported in the Baseline section, Results section, Figure 2, and Supplemental Material. As a result of misclassification of 1 tertiary hospital as being nontertiary, the age- and sex-adjusted hazard ratio (HR) for “Level of hospital at first diagnosis” was incorrect. The fully adjusted HRs for all parameters were also affected because level of hospital was included as a covariate. Most estimates only changed minimally without a change in significance level. The article, including Figure 2 and Supplemental Material, has been updated with the correct estimates.
The distribution of right heart catheterizations according to level of hospital at time of first HF hospitalization is rightfully 226 (33.2%) in tertiary centers and 454 (66.8%) in nontertiary centers versus the originally reported 131 (19.3%) in tertiary and 549 (80.7%) in nontertiary centers; P value for difference remains P<0.001.
After correction, the age- and sex-adjusted HR for tertiary versus nontertiary hospital at time of first HF hospitalization is 2.14 (95% CI, 1.81–2.54; P<0.001) versus previously reported HR 1.68 (95% CI, 1.37–2.05; P<0.001). Correspondingly, fully adjusted HR is rightfully 2.19 (95% CI, 1.84–2.61; P<0.001) versus HR 1.68 (95% CI, 1.37–2.05; P<0.001) reported in the article.
The error does not affect the main conclusions of the article, because the significantly elevated adjusted HRs for the likelihood of referral for invasive evaluation for patients in higher household income groups and with HF diagnosis during hospitalization persists, and as alluded to above the association with presenting at a tertiary center, is strengthened (see revised Table 2 below).
| Age- and sex-adjusted HR (95% CI) | P value | Adjusted* HR (95% CI) | P value | |
|---|---|---|---|---|
| Male sex | 1.15 (0.97–1.36) | 0.1 | 1.16 (0.98–1.38) | 0.08 |
| Age (older) | 0.97 (0.96–0.97) | <0.001 | 0.97 (0.96–0.98) | <0.001 |
| Hospitalized at HF diagnosis | 1.66 (1.42–1.93) | <0.001 | 1.65 (1.41–1.93) | <0.001 |
| Cohabitant | 1.39 (1.17–1.64) | <0.001 | 1.13 (0.92–1.38) | 0.2 |
| Level of hospital at first HF diagnosis | ||||
| Nontertiary | 1.00 (ref.) | 1.00 (ref.) | ||
| Tertiary | 2.14 (1.81–2.54) | <0.001 | 2.19 (1.84–2.61) | <0.001 |
| Income quartile | ||||
| Q1 (lowest) | 1.00 (ref.) | 1.00 (ref.) | ||
| Q2 | 1.24 (0.97–1.58) | 0.08 | 1.19 (0.93–1.53) | 0.2 |
| Q3 | 1.58 (1.26–1.97) | <0.001 | 1.51 (1.18–1.95) | 0.001 |
| Q4 (highest) | 1.58 (1.27–1.97) | <0.001 | 1.56 (1.18–2.05) | 0.002 |
| Educational level | ||||
| Basic school | 1.00 (ref.) | 1.00 (ref.) | ||
| High school | 1.37 (0.95–1.98) | 0.09 | 1.36 (0.94–1.97) | 0.1 |
| Vocational | 1.07 (0.89–1.27) | 0.5 | 0.98 (0.82–1.18) | 0.9 |
| Short/medium length higher education | 1.00 (0.78–1.28) | <1.0 | 0.88 (0.68–1.14) | 0.3 |
| Long length higher education | 1.01 (0.68–1.48) | <1.0 | 0.86 (0.57–1.29) | 0.5 |
| Unknown | 0.87 (0.57–1.32) | 0.5 | 0.78 (0.49–1.25) | 0.3 |
| Occupational status | ||||
| In the workforce† | 1.00 (ref.) | 1.00 (ref.) | ||
| Sick leave/Subsidized work | 1.24 (0.92–1.66) | 0.2 | 1.27 (0.95–1.71) | 0.1 |
| Early retirement | 0.95 (0.76–1.20) | 0.7 | 1.10 (0.86–1.40) | 0.5 |
| Full state pension | 1.06 (0.84–1.34) | 0.6 | 1.17 (0.91–1.51) | 0.2 |
| Distance to tertiary HF hospital‡ | 1.00 (0.98–1.01) | 0.8 | 1.02 (1.00–1.03) | 0.02 |
| Comorbidities | ||||
| Ischemic heart disease | 0.80 (0.67–0.95) | <0.01 | 0.83 (0.70–0.99) | 0.04 |
| Cerebrovascular disease | 0.70 (0.48–1.02) | 0.07 | 0.71 (0.48–1.04) | 0.08 |
| Cancer | 0.66 (0.45–0.97) | 0.03 | 0.61 (0.41–0.90) | 0.01 |
| Cardiac dysrhythmias | 1.23 (1.04–1.45) | 0.02 | 1.13 (0.95–1.34) | 0.2 |
| Peripheral vascular disease | 1.13 (0.79–1.61) | 0.5 | 1.13 (0.78–1.64) | 0.5 |
| Renal disease | 1.49 (1.09–2.03) | 0.01 | 1.49 (1.08–2.06) | 0.02 |
| Diabetes | 0.94 (0.77–1.14) | 0.5 | 0.96 (0.78–1.17) | 0.7 |
| COPD | 0.85 (0.63–1.15) | 0.3 | 0.88 (0.64–1.20) | 0.4 |
| Psychiatric diagnosis | 0.48 (0.31–0.74) | 0.001 | 0.54 (0.35–0.84) | 0.006 |
However, the error did affect the estimates of the association between distance to a tertiary HF center and likelihood of undergoing right heart catheterization. Distance to HF center remained insignificant in age- and sex-adjusted analyses (P=0.83), and only emerge statistically significant in the fully adjusted analysis with HR 1.02 (95% CI, 1.00–1.03; P=0.02) per 10 km longer distance to hospital. This was previously reported as HR 1.01 (95% CI, 0.99–1.02; P=0.5) in the article. The authors believe this statistical association should not be overly emphasized because of its absence in age- and sex-adjusted analyses and the modest point estimate.
The authors regret this error.
This correction has been made to the current version of the article, which is available at https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.008662.