Differences in access to coronary care unit among patients with acute myocardial infarction in Rome: old, ill, and poor people hold the burden of inefficiency

Ancona, Carla; Arcà, Massimo; Saitto, Carlo; Agabiti, Nera; Fusco, Danilo; Tancioni, Valeria; Perucci, Carlo A.

doi:10.1186/1472-6963-4-34

Cited by 30 publications

(26 citation statements)

References 22 publications

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“…Different paradigms of care (comprehensive vs limited assessment) for elderly patients with cardiovascular disease have been undergoing intense debate. 17,18 We found no association between patient age and the quality of stroke care delivery. Even the very elderly (those aged older than 80 years) received thrombolysis, stroke unit care, and other interventions at a similar rate to those seen in younger individuals.…”

Section: Discussionmentioning

confidence: 41%

Age Disparities in Stroke Quality of Care and Delivery of Health Services

Saposnik

Black

Hakim

et al. 2009

Stroke

107

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Working GroupBackground and Purpose-Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age. Methods-This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay. Results-Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home. Conclusions-In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality. (Stroke. 2009;40:3328-3335.)

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Section: Discussionmentioning

confidence: 41%

Age Disparities in Stroke Quality of Care and Delivery of Health Services

Saposnik

Black

Hakim

et al. 2009

Stroke

107

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“…14 Hence, many locations show evidence of treatment disparities, although publication bias may exaggerate such inequality and the causes may not be the same for different treatments and locations.…”

Section: Discussionmentioning

confidence: 99%

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy

Picciotto

Forastiére²,

Stafoggia³

et al. 2006

Journal of Epidemiology & Community Health

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Background: Socioeconomic gradients in the occurrence of myocardial infarction are well known, but few studies have examined socioeconomic disparities in post-infarction outcomes. The objective of this study was to explore relations of socioeconomic status with the incidence, treatment, and outcome of first coronary event in Rome, Italy, during the period 1998-2000, examining effect modification by gender. Methods: Subjects were Rome residents aged 35-84 years who died from first acute coronary event before reaching the hospital (n = 3470) or were hospitalised for first acute myocardial infarction (n = 8467). Area based deprivation status and patients' educational attainment were the exposure variables. The outcomes were: incidence of coronary event; recanalisation at the index hospitalisation and fatality within 28 days of hospitalisation; cardiac readmissions and fatality between 28 days and one year of index hospitalisation. Results: Incidence rates increased as area based deprivation status increased; the effect was stronger among women than among men (men RR = 1.40, 95%CI:1.30, 1.50, women RR = 1.78, 95%CI:1.60, 1.98, most compared with least deprived). Rates of recanalisation were significantly lower in the most deprived patients than in the least deprived (OR = 0.77, 95%CI:0.59, 0.99) and in the less educated than in the highly educated (OR = 0.73, 95%CI:0.58, 0.90). Associations of short term fatality with area based deprivation status and educational attainment were weak and inconsistent. However, neither deprivation status nor education was associated with one year outcomes. Conclusions: Area based deprivation status is strongly related to incidence of coronary events, and more so among women than among men. Deprivation status and educational attainment are weakly and inconsistently associated with short term fatality but seem not to influence one year prognosis of acute myocardial infarction. Deprived and less educated patients experience limited access to recanalisation procedures.

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“…37 Limited education and lack of financial resources may also affect access to quality medical care 38 and decrease adherence to medication. 39 Whatever the mechanism, our findings suggest that patients who have a low income or education level may benefit from more aggressive management of CHD, including treatment of dyslipidemia, hypertension, diabetes, smoking, obesity, and physical inactivity.…”

Section: Discussionmentioning

confidence: 99%

Relation of Low Socioeconomic Status to C-Reactive Protein in Patients With Coronary Heart Disease (from the Heart and Soul Study)

Lubbock

Goh

Ali

et al. 2005

The American Journal of Cardiology

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Low socioeconomic status (SES) is associated with poor health outcomes in patients who have coronary heart disease (CHD). Inflammation is a potential mechanism by which low SES may lead to adverse cardiovascular outcomes, but it is not known whether low SES is associated with inflammation in patients who have CHD. We measured high-sensitivity C-reactive protein (CRP) levels in a cross-sectional study of 985 adults who had CHD. Income and education were determined by self-report. We used ordinal logistic regression to examine the association of income and education with CRP. Of the 985 participants, 390 had high CRP levels (>3 mg/dl). The proportion of participants who had high CRP levels ranged from 30% (103 of 340) in those who had a college degree to 51% (65 of 127) in those who had less than a high school degree (p <0.0001). The proportion of subjects who had a high CRP level ranged from 28% (52 of 183) in those who had annual income >$50,000 to 42% (199 of 974) in those who had an annual income <$20,000 (p <0.001). After adjustment for traditional cardiovascular risk factors and other potential confounding variables, lower income and education remained associated with higher CRP levels. In conclusion, low SES is associated with high CRP levels in patients who have CHD. This observation raises the possibility that inflammation may contribute to the adverse cardiovascular outcomes associated with low SES.To determine the relation between socioeconomic status (SES) and level of C-reactive protein (CRP), we assessed income and education and measured CRP in a cross-sectional study of 985 adults who had coronary heart disease (CHD). We hypothesized that lower income and education would be associated with higher CRP levels after adjusting for demographic characteristics, traditional CHD risk factors, medical co-morbidities, medication use, and other clinical indicators. Methods ParticipantsThe Heart and Soul Study is a prospective cohort study that examines the influence of psychosocial factors on health outcomes in patients who have coronary artery disease. Methods have been described previously. A total of 15,438 eligible patients was mailed an invitation to participate, and 2,495 responded that they would be interested. Of the 2,495 patients whom we attempted to contact by telephone to schedule a study appointment, 505 could not be reached and 596 declined to participate. An additional 370 patients were excluded because they had a history of myocardial infarction in the previous 6 months, deemed themselves unable to walk 1 block, or were planning to move out of the local area within 3 years.Between September 2000 and December 2002, 1,024 participants enrolled and attended a daylong appointment at the Veterans Affairs Medical Center in San Francisco. For this crosssectional study, we excluded 39 subjects from whom we could not obtain serum samples, leaving 985 participants for analysis. This study protocol was approved by the appropriate institutional review boards, and all participants provided written, ...

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Differences in access to coronary care unit among patients with acute myocardial infarction in Rome: old, ill, and poor people hold the burden of inefficiency

Cited by 30 publications

References 22 publications

Age Disparities in Stroke Quality of Care and Delivery of Health Services

Age Disparities in Stroke Quality of Care and Delivery of Health Services

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy

Relation of Low Socioeconomic Status to C-Reactive Protein in Patients With Coronary Heart Disease (from the Heart and Soul Study)

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