{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:42:40Z","timestamp":1789684960716,"version":"4.0.1"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U01\u2010NS\u2010039143 to Dr. Thompson"],"award-info":[{"award-number":["U01\u2010NS\u2010039143 to Dr. Thompson"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U01\u2010NS\u2010043975 to Dr. Homma"],"award-info":[{"award-number":["U01\u2010NS\u2010043975 to Dr. Homma"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>The influence of social determinants of health (SDOH) on the prognosis of Heart Failure and reduced Ejection Fraction (HFrEF) is increasingly reported. We aim to evaluate the contribution of educational status on outcomes in patients with HFrEF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from the WARCEF trial, which randomized HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational status of patients enrolled was collected at baseline. We defined three levels of education: low, medium and high level, according to the highest qualification achieved or highest school grade attended. We analysed the impact of the educational status on the risk of the primary composite outcome of all\u2010cause death, ischemic stroke (IS) and intracerebral haemorrhage (ICH); components of the primary outcome were also analysed as secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>2295 patients were included in this analysis; of these, 992 (43.2%) had a low educational level, 947 (41.3%) had a medium education level and the remaining 356 (15.5%) showed a high educational level. Compared to patients with high educational level, those with low educational status showed a high risk of the primary composite outcome (adjusted hazard ratio [aHR]: 1.31, 95% confidence intervals [CI] 1.02\u20131.69); a non\u2010statistically significant association was observed in those with medium educational level (aHR: 1.20, 95%CI: .93\u20131.55). Similar results were observed for all\u2010cause death, while no statistically significant differences were observed for IS or ICH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared to patients with high educational levels, those with low educational status had worse prognosis. SDOH should be considered in patients with HFrEF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>NCT00041938.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.14152","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T11:20:07Z","timestamp":1704972007000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Educational status affects prognosis of patients with heart failure with reduced ejection fraction: A post\u2010hoc analysis from the <scp>WARCEF<\/scp> trial"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9460-4435","authenticated-orcid":false,"given":"Bernadette","family":"Corica","sequence":"first","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"},{"name":"Department of Translational and Precision Medicine Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio Francesco","family":"Romiti","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"},{"name":"Department of Translational and Precision Medicine Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalie Helme","family":"Simoni","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"},{"name":"Department of Clinical Medicine, Danish Center for Health Services Research Aalborg University  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide Antonio","family":"Mei","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"},{"name":"Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Bucci","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"},{"name":"Department of General and Specialized Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L. P.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Mailman School of Public Health Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Qian","sequence":"additional","affiliation":[{"name":"Mailman School of Public Health Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Homma","sequence":"additional","affiliation":[{"name":"Cardiology Division Columbia University Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1452-2478","authenticated-orcid":false,"given":"Marco","family":"Proietti","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health University of Milan  Milan Italy"},{"name":"Division of Subacute Care IRCCS Istituti Clinici Scientifici Maugeri  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. 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