Influence of socioeconomic status on clinical outcomes and quality of life after percutaneous coronary intervention

Abstract

Objectives: To determine whether socioeconomic status (SES) influences clinical outcomes and quality of life after percutaneous coronary intervention (PCI). Design: Prospective observational study. Setting: Two interventional cardiac centres. Participants: 1346 consecutive patients undergoing PCI over a 12-month period. Outcomes: Self reported health-related quality of life (HRQoL; EuroQol-5 Dimensions (EQ-5D); EuroQol Visual Analogue Scale (EQ-VAS)), repeat angiography, revascularisation, hospital admission, myocardial infarction and death within 12 months, by SES derived using postal address code. Main results: No significant differences were found between patients with high and low SES in the occurrence of repeat angiography (p = 0.55), repeat revascularisation (PCI, p = 0.81, CAEG, p = 0.27), total cardiac hospitalisation (p = 0.10), myocardial infarction (p = 0.97) or death 12 months after PCI (p = 0.88). Non-procedure-related readmissions were higher in patients with low SES (18.6% v 13.7%; p = 0.025). After adjustment for confounding factors, patients with low SES had lower HRQoL scores at baseline (95% CI for difference 0.01 to 0.14; p = 0.003) and at 12 months (95% CI 0.07 to 0.17; p,0.001) compared with those with high SES. Conclusions: Clinical outcomes were similar for patients in different SES groups. Patients with low SES had considerably more non-procedure-related readmissions and lower quality-of-life scores. Future studies on HRQoL after coronary revascularisation should take account of these important differences related to SES.

Socioeconomic status, cognitive-emotional factors, and health status following myocardial infarction: testing the Reserve Capacity Model

“…Next, associations between SES, cognitive-emotional factors, and health status appraisals one year following MI were examined. Consistent with other investigators, results showed low SES was associated with poor health status appraisals (e.g., Barbareschi et al, 2009;Denvir et al, 2006;Peters-Klimm et al, 2010). Of most relevance to the current study, results mostly supported the RCM when predicting psychological health status appraisals, particularly for the SF-12 MCS.…”

“…Quality of life is conceptualized as a patient's general sense of his/her health and well-being, and is generally best assessed through direct patient appraisals (Gyatt et al, 1993). Patients from low SES backgrounds who were treated with percutaneous coronary intervention had lower health-related quality of life during hospitalization and 12 months later than high SES patients (Denvir et al, 2006). A prospective study of older patients with CVD also showed differences in quality of life by SES before disease onset, and at 6 and 12 months post-diagnosis (Barbareschi et al, 2009).…”

Impact of the community's socioeconomic status on characteristics and outcomes of patients undergoing percutaneous coronary intervention

“…Denvir et al found no significant association between the individual's SES and cardiovascular outcomes [13]. This study may have been underpowered and was conducted before the introduction of drug eluting stents (DES), the utilization of which might be different among patients of different SES [14,15].…”

Evaluation of quality of life among patients with ischemic heart disease who practiced self-care activities at home after elective percutaneous coronary intervention

“…However, post-PCI QOL does not necessarily improve relative to pre-PCI in all patients. Factors affecting QOL among patients after elective PCI include smoking, weight gain, depression, unemployment and lack of family help [7][8][9][10][11][12][13][14][15]. Among these factors, smoking and weight gain are closely associated with lifestyle.…”