Abstract: Objective To investigate the impact of socioeconomic status (SES) on treatment-seeking delay behavior among hospitalized patients with heart failure (HF) and to explore the mediating mechanisms of health literacy, social support, and coping styles, thereby providing an evidence-based foundation for developing targeted intervention strategies. Methods A total of 232 patients diagnosed with HF and admitted to a hospital in Linquan Country between January 2024 and October 2025 were enrolled in this study. Data were collected on patients' SES (a composite index derived from principal component analysis), treatment-seeking delay time (dichotomized based on a median of 36.5 hours), general clinical characteristics, and prognostic outcomes. Health literacy, social support, and coping styles were assessed using the Health Literacy Scale for Chronic Patients (HLSCP), the Social Support Rating Scale (SSRS), and the Medical Coping Modes Questionnaire (MCMQ), respectively. A mediation analysis was conducted using PROCESS model 4, with the SES composite index as the independent variable, treatment-seeking delay as the dependent variable, and health literacy, social support, and coping styles as mediating variables. Results The final analysis included 229 HF patients. The median treatment-seeking delay time was 37.00 hours, with 112 patients (48.9%) classified into the delay group. The SES composite index was significantly lower in the delay group [-0.35 (-1.02, 0.21)] compared to the timely treatment group [0.18 (-0.41, 0.79)] (P<0.01). Multivariate analysis revealed that for each unit increase in the SES composite index, the risk of treatment-seeking delay decreased by 34.4% (OR=0.656, 95% CI: 0.527-0.818). The mediation analysis indicated a total effect of SES on treatment-seeking delay of -0.182, with a direct effect of -0.123 and a total indirect effect of -0.059, accounting for 32.4% of the total effect. Regarding prognosis, the delay group exhibited a longer length of hospital stay and significantly higher rates of 30-day all-cause readmission, HF-related readmission, and mortality compared to the timely treatment group (P<0.05 or P<0.01). Conclusion Lower socioeconomic status is associated with an increased risk of treatment-seeking delay in patients with heart failure. This relationship is both direct and indirect, with the indirect pathway being mediated by health literacy, social support, and a resignated coping style, which collectively account for 32.4% of the total effect. This delay subsequently contributes to prolonged hospitalization, elevated readmission rates, and higher mortality. Clinical practice should prioritize patients with low SES, implementing interventions aimed at enhancing health literacy, strengthening social support, and improving coping strategies to mitigate treatment-seeking delays and improve patient outcomes.

Key words: Heart failure, Treatment-seeking delay, Socioeconomic status, Health literacy, Social support, Coping style