Impact of Socioeconomic Status on Clinical Outcomes in Patients With ST-Segment–Elevation Myocardial Infarction

Biswas, Sinjini; Andrianopoulos, Nick; Duffy, Stephen J.; Lefkovits, Jeffrey; Brennan, A.; Walton, Antony; Chan, William; Noaman, Samer; Shaw, James A.; Ajani, A.; Clark, David; Freeman, Melanie; Hiew, C.; Oqueli, Ernesto; Reid, Christopher M.

doi:10.1161/circoutcomes.118.004979

Cited by 41 publications

(48 citation statements)

References 29 publications

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“…We noted greater use of PAC in admissions with higher socioeconomic status and bearing insurance coverage, which may allude to social disparities noted in other AMI populations. 47,48 Furthermore, the use of PAC in large urban hospitals and in patients with MCS demonstrates the paradigm shift in the management of AMI-CS with the advent of newer percutaneous MCS devices. 15,43,49,50 Second, with advanced MCS being available in the contemporary era, 6,7,28,29,[51][52][53] PAC is being increasingly used to treat patients with higher severity of illness.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

et al. 2020

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Aims The aim of this study is to evaluate the contemporary use of a pulmonary artery catheter (PAC) in acute myocardial infarction-cardiogenic shock (AMI-CS). Methods and results A retrospective cohort of AMI-CS admissions using the National Inpatient Sample (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) was identified. Admissions with concomitant cardiac surgery or non-AMI aetiology for cardiogenic shock were excluded. The outcomes of interest were in-hospital mortality, resource utilization, and temporal trends in cohorts with and without PAC use. In the non-PAC cohort, the use and outcomes of right heart catheterization was evaluated. Multivariable regression and propensity matching was used to adjust for confounding. During 2000-2014, 364 001 admissions with AMI-CS were included. PAC was used in 8.1% with a 75% decrease during over the study period (13.9% to 5.4%). Greater proportion of admissions to urban teaching hospitals received PACs (9.5%) compared with urban non-teaching (7.1%) and rural hospitals (5.4%); P < 0.001. Younger age, male sex, white race, higher comorbidity, noncardiac organ failure, use of mechanical circulatory support, and noncardiac support were independent predictors of PAC use. The PAC cohort had higher in-hospital mortality (adjusted odds ratio 1.07 [95% confidence interval 1.04-1.10]), longer length of stay (10.9 ± 10.9 vs. 8.2 ± 9.3 days), higher hospitalization costs ($128 247 ± 138 181 vs. $96 509 ± 116 060), and lesser discharges to home (36.3% vs. 46.4%) (all P < 0.001). In 6200 propensity-matched pairs, in-hospital mortality was comparable between the two cohorts (odds ratio 1.01 [95% confidence interval 0.94-1.08]). Right heart catheterization was used in 12.5% of non-PAC admissions and was a marker of greater severity but did not indicate worse outcomes. Conclusions In AMI-CS, there was a 75% decrease in PAC use between 2000 and 2014. Admissions receiving a PAC were a higher risk cohort with worse clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

et al. 2020

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“…A previous Australian study found similar results in patients with acute myocardial infarction (AMI). Here, lower educational level was associated with higher co-morbidity and ongoing smoking but not with risk of cardiac events after 12 months [23]. Furthermore, a Danish study found employment status and income but not educational level to be associated with an increased risk of cardiac events in patients undergoing percutaneous coronary intervention [24].…”

Section: Discussionmentioning

confidence: 99%

Educational inequality in patient-reported outcomes but not mortality among cardiac patients: Results from the national DenHeart survey with register follow-up

Christensen

Juel

Ekholm

et al. 2020

Scand J Public Health

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Aims: This study aimed to explore whether educational level is associated with mental and physical health status, anxiety and depression symptoms and quality of life at hospital discharge and predicts cardiac events and all-cause mortality 1 year after hospital discharge in patients with ischaemic heart disease, arrhythmias, heart failure or heart valve disease. Methods: The DenHeart survey is cross-sectional and combined with data from national registers. Information on educational level and co-morbidity at hospital discharge and cardiac events and mortality 1-year post-discharge was obtained from registers. Patient-reported outcomes included SF-12, Hospital Anxiety and Depression Scale and HeartQoL. Multivariate linear and logistic regression and Cox proportional hazards regression models were used. Results: A total of 13,145 patients were included. A significant educational gradient was found in patient-reported mental and physical health status, anxiety and depression symptoms and quality of life, with lower educational groups reporting worse outcomes in adjusted analyses. No association was found between educational level and risk of cardiac events or all-cause mortality within 1 year after hospital discharge in adjusted analyses. Conclusions: In a large population of patients with cardiac disease a significant educational gradient was found in mental and physical health and quality of life at hospital discharge. There was, however, no association between educational level and risk of cardiac events or mortality 1 year after hospital discharge.

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“…The same study in Indonesia also explained that the collectivist culture in Indonesia provides an advantage for women as they can easily get support from their core family, relatives, or friends [16]. Financial support through health insurance is essential for the sustainability of the health-care process even though low socioeconomic status is not associated with adverse clinical outcomes [24]. In a qualitative study in Denmark, patients in various socioeconomic subgroups felt excluded from cardiac rehabilitation for various reasons [25].…”

Section: Discussionmentioning

confidence: 99%

Patient’s Transition Experiences from Hospital to Home after an Acute Cardiac Event

Khoiriyati

Kusnanto

Kurniawati

et al. 2021

Open Access Maced J Med Sci

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BACKGROUND: Care transition after hospital discharge is challenging for patients and their families. For post an acute cardiac event patients, the 0–14 days period is a vulnerable period. After hospitalization, patients and their families report having unmet information needs at a time of hospital discharge. It can increase the complication and hospital readmission. AIM: This study aim to explore the patient’s transition experiences from hospital to home after an acute cardiac event. METHODS: An exploratory qualitative research design with phenomenological approach was used in the study. The data were collected from April to July 2020, using semi-structured interviews with 15 patients diagnosed with acute coronary syndrome (ACS). Transcribed interview data were thematically analyzed. RESULTS: There are five themes obtained from the study: Positive perception after an acute cardiac event, the changes experienced, the knowledge which was required, the support needs, and expectations and goals. CONCLUSION: Transition from hospital to home depends on the perceptions of the participants themselves. The experience of transitioning patients from hospital to home was influenced by the existence of support from family, spiritual meaning, and social environment to be able to adapt to health conditions. The finding of this study can assist the nurses in understanding better the needs of patients to prepare the care transition from the hospital to home.

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Impact of Socioeconomic Status on Clinical Outcomes in Patients With ST-Segment–Elevation Myocardial Infarction

Cited by 41 publications

References 29 publications

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

Pulmonary artery catheter use in acute myocardial infarction‐cardiogenic shock

Educational inequality in patient-reported outcomes but not mortality among cardiac patients: Results from the national DenHeart survey with register follow-up

Patient’s Transition Experiences from Hospital to Home after an Acute Cardiac Event

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