George Andrikopoulos1, Stylianos Tzeis2, Dimitrios Terentes-Printzios3, Christos Varounis4, Charalampos Vlachopoulos3, Ioannis Mantas5, Sotirios Patsilinakos6, Stylianos Lampropoulos7, Christoforos Olympios8, Athanasios Kartalis9, Athanasios Manolis10, Alexandros Gotsis11, Filippos Triposkiadis12, Themistoklis Tsaknakis13, Ioannis Goudevenos14, Ioannis Kaprinis15, Athanasios Pras16, Fotios Vasiliou17, Emmanouil Skoumpourdis18, Gerasimoula Sakka19, Antonios Draganigos20, Panos Vardas21. 1. Henry Dunant Hospital Center Athens, 18 Parmenionos Street, 13676, Thrakomakedones, Greece. andrikop@hotmail.com. 2. Henry Dunant Hospital Center Athens, 18 Parmenionos Street, 13676, Thrakomakedones, Greece. 3. Hippokration Hospital, University of Athens Medical School, Athens, Greece. 4. Attikon University Hospital, Athens, Greece. 5. General Hospital of Halkida, Chalkida, Greece. 6. Konstantopoulio General Hospital, Athens, Greece. 7. Bodosakeio General Hospital of Ptolemaida, Ptolemaida, Greece. 8. Thriassio General Hospital, Athens, Greece. 9. Skylitsion General Hospital of Chios, Chios, Greece. 10. Asklipio General Hospital of Voula, Voula, Greece. 11. General Hospital of Komotini, Komotini, Greece. 12. University Hospital of Larissa, Larissa, Greece. 13. Achilopouleio General Hospital of Volos, Volos, Greece. 14. University Hospital of Ioannina, Ioannina, Greece. 15. Papageorgiou General Hospital, Pavlos melas, Greece. 16. General Hospital of Chania, Mournies, Greece. 17. General Hospital Larissa, Larissa, Greece. 18. General Hospital of Thiva, Thiva, Greece. 19. General Hospital of Preveza, Preveza, Greece. 20. General Hospital of Corfu, Corfu, Greece. 21. University Hospital of Heraklion, Heraklion, Greece.
Abstract
BACKGROUND: The effect of income status on patient outcome merits investigation during periods of financial crisis. We evaluated the impact of income status on out-of-hospital prognosis in a cohort of acute coronary syndrome (ACS) patients, included in a countrywide study during a period of financial crisis. METHODS: The study is a secondary analysis of a prospective, multicenter, observational study-the PHAETHON study-enrolling consecutive ACS patients in 37 hospitals in Greece. Patients were classified as low or high income based on the reported net annual household income using as a cut-off point the relative poverty threshold for Greece of 12,000 Euros. The outcome measure was survival free of the primary composite endpoint (cardiovascular death, myocardial infarction, stroke/transient ischemic attack, urgent revascularization and urgent hospitalization due to cardiovascular causes). RESULTS: The study population included 794 patients. The administration rate of evidence-based medications was similar in the low- (n = 455) and high-income (n = 339) groups during hospitalization and upon discharge. In a median follow-up of 189 days (interquartile range: 180-212 days), low-income patients had 92 % higher risk of the combined endpoint as compared to high-income patients [Hazard ratio (HR):1.92, 95 % CI:1.25-2.94, p = 0.003]. The effect of low-income status on the combined outcome remained significant after adjustment for age, gender and depression (HR:1.59, 95 % CI:1.02-2.49; p = 0.043). CONCLUSIONS: In a period of financial crisis, low income is a significant and independent predictor of poor out-of-hospital outcome in ACS patients. This association has profound implications and should be taken into consideration by public health policy makers.
BACKGROUND: The effect of income status on patient outcome merits investigation during periods of financial crisis. We evaluated the impact of income status on out-of-hospital prognosis in a cohort of acute coronary syndrome (ACS) patients, included in a countrywide study during a period of financial crisis. METHODS: The study is a secondary analysis of a prospective, multicenter, observational study-the PHAETHON study-enrolling consecutive ACS patients in 37 hospitals in Greece. Patients were classified as low or high income based on the reported net annual household income using as a cut-off point the relative poverty threshold for Greece of 12,000 Euros. The outcome measure was survival free of the primary composite endpoint (cardiovascular death, myocardial infarction, stroke/transient ischemic attack, urgent revascularization and urgent hospitalization due to cardiovascular causes). RESULTS: The study population included 794 patients. The administration rate of evidence-based medications was similar in the low- (n = 455) and high-income (n = 339) groups during hospitalization and upon discharge. In a median follow-up of 189 days (interquartile range: 180-212 days), low-income patients had 92 % higher risk of the combined endpoint as compared to high-income patients [Hazard ratio (HR):1.92, 95 % CI:1.25-2.94, p = 0.003]. The effect of low-income status on the combined outcome remained significant after adjustment for age, gender and depression (HR:1.59, 95 % CI:1.02-2.49; p = 0.043). CONCLUSIONS: In a period of financial crisis, low income is a significant and independent predictor of poor out-of-hospital outcome in ACS patients. This association has profound implications and should be taken into consideration by public health policy makers.
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