Sinjini Biswas1,2, Nick Andrianopoulos1, Stephen J Duffy1,2, Jeffrey Lefkovits1,3, Angela Brennan1, Antony Walton2, William Chan2,4, Samer Noaman2, James A Shaw2, Andrew Ajani1,3, David J Clark5, Melanie Freeman6, Chin Hiew7, Ernesto Oqueli8, Christopher M Reid1,9, Dion Stub1,2,4. 1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.). 2. Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.). 3. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (J.L., A.A.). 4. Baker IDI Heart and Diabetes Institute, Melbourne, Australia (W.C., D.S.). 5. Department of Cardiology, Austin Health, Melbourne, Australia (D.J.C.). 6. Department of Cardiology, Box Hill Hospital, Melbourne, Australia (M.F.). 7. Department of Cardiology, University Hospital Geelong, Australia (C.H.). 8. Department of Cardiology, Ballarat Health Services, Australia (E.O.). 9. School of Public Health, Curtin University, Perth, Australia (C.M.R.).
Abstract
BACKGROUND: Low socioeconomic status (SES) has been previously shown to be associated with worse cardiovascular outcomes. However, unlike in Australia, many of these studies have been performed in countries without universal healthcare where SES may be expected to have a greater impact on care and outcomes. We sought to determine whether there is an association between SES and baseline characteristics, clinical outcomes and use of secondary prevention therapy in patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: We prospectively collected data on 5665 consecutive ST-segment-elevation myocardial infarction PCI patients between 2005 and 2015 from 6 government-funded hospitals participating in a multicenter registry. Patients were categorized into SES quintiles using the Index of Relative Socioeconomic Disadvantage system, a score allocated to each residential postcode based on factors like income, educational level, and employment status by the Australian Bureau of Statistics. In our study, lower SES patients were more likely to have diabetes mellitus, smoke, and initially present to a non-PCI capable hospital (all P≤0.01). Among primary PCI patients, the median time to reperfusion was slightly higher in lower SES groups (211 [144-337] versus 193 [145-285] minutes, P<0.001). Drug-eluting stent use was higher in the higher SES groups ( P<0.001). At 12 months after PCI, lower SES patients had higher rates of ongoing smoking and lower use of guideline-recommended secondary prevention therapy (both P<0.01). Despite these differences, SES group was not found to be an independent predictor of 12-month major adverse cardiovascular events. CONCLUSIONS: Lower SES patients have more comorbidities and experienced slightly longer reperfusion times but otherwise similar care. Despite these baseline differences, clinical outcomes after ST-segment-elevation myocardial infarction PCI were similar regardless of SES.
BACKGROUND: Low socioeconomic status (SES) has been previously shown to be associated with worse cardiovascular outcomes. However, unlike in Australia, many of these studies have been performed in countries without universal healthcare where SES may be expected to have a greater impact on care and outcomes. We sought to determine whether there is an association between SES and baseline characteristics, clinical outcomes and use of secondary prevention therapy in patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: We prospectively collected data on 5665 consecutive ST-segment-elevation myocardial infarction PCIpatients between 2005 and 2015 from 6 government-funded hospitals participating in a multicenter registry. Patients were categorized into SES quintiles using the Index of Relative Socioeconomic Disadvantage system, a score allocated to each residential postcode based on factors like income, educational level, and employment status by the Australian Bureau of Statistics. In our study, lower SES patients were more likely to have diabetes mellitus, smoke, and initially present to a non-PCI capable hospital (all P≤0.01). Among primary PCI patients, the median time to reperfusion was slightly higher in lower SES groups (211 [144-337] versus 193 [145-285] minutes, P<0.001). Drug-eluting stent use was higher in the higher SES groups ( P<0.001). At 12 months after PCI, lower SES patients had higher rates of ongoing smoking and lower use of guideline-recommended secondary prevention therapy (both P<0.01). Despite these differences, SES group was not found to be an independent predictor of 12-month major adverse cardiovascular events. CONCLUSIONS: Lower SES patients have more comorbidities and experienced slightly longer reperfusion times but otherwise similar care. Despite these baseline differences, clinical outcomes after ST-segment-elevation myocardial infarction PCI were similar regardless of SES.
Authors: Syed F Mujtaba; Muhammad N Khan; Hina Sohail; Jawaid A Sial; Musa Karim; Tahir Saghir; Kiran Abbas; Moiz Ahmed; Nadeem Qamar Journal: Cureus Date: 2020-05-28
Authors: Jason E Bloom; Emily Andrew; Luke P Dawson; Ziad Nehme; Michael Stephenson; David Anderson; Himawan Fernando; Samer Noaman; Shelley Cox; Catherine Milne; William Chan; David M Kaye; Karen Smith; Dion Stub Journal: JAMA Netw Open Date: 2022-01-04
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Authors: Luke P Dawson; Emily Andrew; Ziad Nehme; Jason Bloom; Sinjini Biswas; Shelley Cox; David Anderson; Michael Stephenson; Jeffrey Lefkovits; Andrew J Taylor; David Kaye; Karen Smith; Dion Stub Journal: J Am Heart Assoc Date: 2022-03-24 Impact factor: 6.106