Among 6,702 adults hospitalized for heart failure with preserved ejection fraction (HFpEF) between 2014 and 2022, neighborhood socioeconomic environment independently predicted when—not just whether—patients returned to the hospital. Patients in the most deprived neighborhoods (NEnv-3 and NEnv-4) faced 63–76% higher 30-day readmission risk and 72–84% higher re-encounter risk. A striking delayed-risk pattern emerged in NEnv-2, where readmission hazard peaked at 90–365 days post-discharge (aHR 3.42), nearly tripling compared to the reference group. Recurrent hospitalization (≥2 admissions) was 64% more likely in NEnv-4 patients.
HFpEF is notoriously difficult to manage—unlike HFrEF, it lacks disease-modifying therapies with robust mortality benefit, making prevention of decompensation critical. Prior work links social determinants broadly to cardiovascular outcomes, but this analysis advances the field by revealing that neighborhood context shapes the *timing* of vulnerability, not merely its magnitude. That finding has direct clinical utility: early outpatient follow-up programs address early readmission risk but may miss delayed-risk patients in moderate-deprivation neighborhoods, who appear stable initially then deteriorate months later—possibly reflecting slower erosion of medication adherence, nutrition, or care access.
Limitations are significant: retrospective ZIP-code-level clustering cannot capture individual-level social circumstances, causality cannot be inferred, and unmeasured confounders remain. As a preprint not yet peer-reviewed, these results require independent validation before influencing care protocols. Still, the temporal granularity here is genuinely novel and could meaningfully reshape post-discharge surveillance design for HFpEF.
