The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project

Niu, Shaoli; Zhao, Dong; Zhu, Jun; Li, Jun; Liu, Qun; Liu, Jing; Wang, Wei; Smith, Sidney C.

doi:10.1016/j.ahj.2008.12.009

Cited by 43 publications

(37 citation statements)

References 9 publications

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“…Similarly, treatment rates with clopidogrel and statins have been shown to be 6.7% and 34.2%, respectively, in patients with the lowest socioeconomic status and 41.7% and 75%, respectively, in patients with the highest socioeconomic status. 25 Recent health reforms have reduced out-of-pocket payments by providing wider insurance cover and establishing a national essential medication system. 24,26 These policy changes may help reduce the sometimes catastrophic costs of ACS to individual patients and households.…”

Section: Discussionmentioning

confidence: 99%

System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China

Ranasinghe

Yao

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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209C hina, a country in the midst of an epidemiological transition, faces many challenges in implementing evidence-based care to curb the growing burden of coronary disease. An aging population and increasing prevalence of cardiovascular risk factors have led to an epidemic of acute coronary syndrome (ACS) across China.1,2 Effective therapies for ACS care, however, continue to be variably used with widespread inequities.3 Furthermore, hospital human resources and adoption of technologies also vary substantially and are particularly limited in rural areas. 4,5 This suggests the presence of significant barriers to implementing change, yet our understanding of these barriers within the healthcare system of China is limited. Particularly, how system factors, that is, the organizational structures, health policies, and the wider social, economic, and political context, may affect efforts to implement evidence at the point of care is largely unknown.Understanding these system barriers is critical given their influence on quality of care. Organizational and wider system factors have been consistently shown to have a significant influence on organizational change, success or failure of implementation of interventions, and their effectiveness. [6][7][8][9] For example, in acute myocardial infarction care, differences in organizational values and goals, senior management involvement, and expertise in acute myocardial infarction care have been identified between high-and low-performing hospitals.10 However, much of our existing understanding about how system factors influence care comes from high-income countries. How they affect care in the unique and dynamic Background-Organizational and wider health system factors influence the implementation and success of interventions.Clinical Pathways in Acute Coronary Syndromes 2 is a cluster randomized trial of a clinical pathway-based intervention to improve acute coronary syndrome care in hospitals in China. We performed a qualitative evaluation to examine the system-level barriers to implementing clinical pathways in the dynamic healthcare environment of China. Methods and Results-A qualitative descriptive analysis of 40 in-depth interviews with health professionals conducted in a sample of 10 hospitals purposively selected to explore barriers to implementation of the intervention. Qualitative data were analyzed using the Framework method. In-depth interviews identified 5 key system-level barriers to effective implementation: (1) leadership support for implementing quality improvement, (2) variation in the capacity of clinical services and quality improvement resources, (3) fears of patient disputes and litigation, (4) healthcare funding constraints and high out-of-pocket expenses, and (5) patient-related factors. Conclusions-System-level barriers affect the ability of acute coronary syndrome clinical pathways to change practice.Addressing these barriers in the context of current and planned national health system reform will be critical for future improvements in the managemen...

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Section: Discussionmentioning

confidence: 99%

System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China

Ranasinghe

Yao

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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“…Increased affordability of therapies via increased access to medical insurance, reduced costs of medical care, or supplemented income among the low SES population might lessen the disparities shown (24). Fortunately, Chinese authorities have launched major reforms of the healthcare system to address these problems (42).…”

Section: Discussionmentioning

confidence: 99%

“…The SES score assigned to each patient was the sum of education, annual household income, occupation, and medical reimbursement scores, as previously described (24)(25)(26). For ease of presentation and interpretation, we analyzed the study sample after stratifying by approximate tertiles of the score distribution ( Figure E1 in the online supplement): less than or equal to 5 (n ¼ 73), 6 to 7 (n ¼ 90), and greater than or equal to 8 (n ¼ 99).…”

Section: Socioeconomic Measuresmentioning

confidence: 99%

Lower Socioeconomic Status Is Associated with Worse Outcomes in Pulmonary Arterial Hypertension

Yang²,

Peng³

et al. 2013

Am J Respir Crit Care Med

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Rationale: Lower socioeconomic status (SES) confers a heightened risk of common cardiovascular and pulmonary diseases and increased mortality. The association of SES with outcomes in patients with pulmonary arterial hypertension (PAH) is less clear. Objectives: To determine the association between SES and outcomes in patients with PAH. Methods: We performed a prospective cohort study at a national referral center for patients with PAH in China. Two hundred sixty-two consecutive incident patients aged 18 to 65 years with a diagnosis of idiopathic PAH were recruited between January 2007 and June 2011 and followed up until November 2011. The primary endpoint was all-cause mortality. An SES score for each patient was derived from their educational level, annual household income, occupation, and medical reimbursement rate. Measurements and Main Results: Patients with a lower SES had higher unadjusted mortality rates, with 3-year survival estimates of 50.1, 70.8, and 86.0% in increasing tertiles of SES (P for trend , 0.001). After adjustment for clinical features, hemodynamics, and type of PAH treatment, the hazard ratios for death were 2.98 (95% confidence interval, 1.51-5.89) in the lowest tertile of SES and 1.80 (95% confidence interval, 0.89-3.63) in the middle tertile of SES compared with the upper tertile (P for trend ¼ 0.006).Conclusions: A lower SES is strongly associated with a higher risk of death in idiopathic PAH. This association was independent of clinical characteristics, hemodynamics, and treatment. Addressing the health disparities associated with a lower SES may improve the outcomes of patients with PAH.Keywords: pulmonary arterial hypertension; socioeconomic status; survival Pulmonary arterial hypertension (PAH) is a disease of the small muscular pulmonary arteries characterized by a progressive rise in pulmonary artery pressure and pulmonary vascular resistance (PVR), ultimately resulting in right heart failure and death (1-3). Treatment for PAH includes anticoagulants, diuretics, prostanoids, phosphodiesterase 5 inhibitors, and endothelin receptor antagonists (ERAs) (3-5). Although survival may have improved, patients with PAH still have a greatly increased risk of death, even with approved treatments. Socioeconomic status (SES) is defined by education, income, occupation, and social status and refers to an individual's social standing relative to other members of a society (6). A low SES is associated with increased risks of cardiovascular and pulmonary disease and mortality (7-11). However, the association of SES with outcomes in PAH has not been well studied.Socioeconomic-related inequalities in health and healthcare have increased over recent decades in . Approximately 75 to 80% of individuals with low annual household incomes do not carry medical insurance (15), potentially greatly increasing the economic burden of PAH on patients. Wilkens and colleagues reported that each patient with PAH in Germany spends €47,400 per year on average, primarily due to drug costs (16,17). In the United States...

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“…As part of a nationwide survey -the Bridging the Gap on CHD Secondary Prevention in China (BRIG) project [12], results from the present study provide firsthand information for future improvement of treatments of Chinese ACS patients during the acute hospitalization. presumptive diagnosis, and had at least one of the following: ECG changes consistent with ACS, serial increases in serum biochemical markers of cardiac necrosis, and/or documentation of coronary artery diseases.…”

Section: Introductionmentioning

confidence: 94%

Impact of heart failure on in-hospital outcomes of acute coronary syndrome patients in China — Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) project

Wang¹,

Zhao²,

Liu³

et al. 2012

International Journal of Cardiology

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The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project

Cited by 43 publications

References 9 publications

System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China

System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China

Lower Socioeconomic Status Is Associated with Worse Outcomes in Pulmonary Arterial Hypertension

Impact of heart failure on in-hospital outcomes of acute coronary syndrome patients in China — Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) project

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