Impact of Socioeconomic Status on In-Hospital Outcome of Patients with Acute Coronary Syndrome in Egypt
Clinical Medicine Research
Volume 6, Issue 6, November 2017, Pages: 164-172
Received: Sep. 15, 2017;
Accepted: Oct. 11, 2017;
Published: Nov. 20, 2017
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Ahmed Hosny El-Adawy, Department of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ghada Elkhawaga, Department of Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Samir Abd Elraheem, Department of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Essam Mahfouz, Department of Cardiovascular Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Cardiovascular problems are still the leading cause of deaths globally. Socioeconomic inequality continues to pose a challenge to health care suppliers and can greatly affect the clinical outcome of medical problems, especially in the cardiovascular field. This study aimed to assess the in-hospital outcome of patients with acute coronary syndrome admitted in the coronary care unit and to determine the relation between socioeconomic status (SES) and in-hospital outcome of acute coronary syndrome. A prospective observational study was conducted on 301 patients presented with acute coronary syndrome during the period from August 2015 to May 2016. A questionnaire was used to assess their socioeconomic status. Admitted patients with acute coronary syndrome (ACS) were classified into 31 (10.3%) patients with non-ST segment elevation myocardial infarction (NSTEMI), 162 (53.8%) with ST segment elevation myocardial infarction STEMI and 108 (35.9%) with unstable angina (UA). According to patients SES, they were classified as 77 with high SES, 74 with middle SES, 84 with low SES, and 66 with very low SES. The study revealed that the lower socioeconomic status was statistically significant associated with increase of acute coronary syndrome mortality (P <0.001), the incidence of impaired left ventricular function, heart failure and stroke was associated. While, lower socioeconomic status was significantly associated decrease in the incidence of coronary angiography and percutaneous intervention. No significant change in the incidence of arrhythmia and major bleeding between socioeconomic status classes. Lower socioeconomic status in patients with acute coronary syndrome was considered as a risk factor for increased in-hospital mortality, stroke, impaired left ventricular function, and heart failure. To the best of author’s knowledge, this study considered first report in Egypt discussing the in-hospital outcome of patients with ACS and to determine the relation between SES and in-hospital outcome of ACS patients.
Ahmed Hosny El-Adawy,
Samir Abd Elraheem,
Impact of Socioeconomic Status on In-Hospital Outcome of Patients with Acute Coronary Syndrome in Egypt, Clinical Medicine Research.
Vol. 6, No. 6,
2017, pp. 164-172.
Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. European heart journal. 2014:ehu299.
Siegerink B, Maas R, Vossen CY, Schwedhelm E, Koenig W, Böger R, et al. Asymmetric and symmetric dimethylarginine and risk of secondary cardiovascular disease events and mortality in patients with stable coronary heart disease: the KAROLA follow-up study. Clinical Research in Cardiology. 2013;102:193-202.
Velagaleti RS, Pencina MJ, Murabito JM, Wang TJ, Parikh NI, D'Agostino RB, et al. Long-term trends in the incidence of heart failure after myocardial infarction. Circulation. 2008;118:2057-62.
Myerson M, Coady S, Taylor H, Rosamond WD, Goff DC, investigators A. Declining Severity of Myocardial Infarction From 1987 to 2002 The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2009;119:503-14.
Rogers WJ, Frederick PD, Stoehr E, Canto JG, Ornato JP, Gibson CM, et al. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. American heart journal. 2008;156:1026-34.
Brieger D, Fox KA, FitzGerald G, Eagle KA, Budaj A, Avezum A, et al. Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2009;95:888-94.
Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 1). Journal of epidemiology and community health. 2006;60:7-12.
Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, et al. Association of socioeconomic position with health behaviors and mortality. Jama. 2010;303:1159-66.
Avendano M, Kunst AE, Huisman M, Lenthe FV, Bopp M, Regidor E, et al. Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s. Heart. 2006;92:461-7.
Lammintausta A. Effects of Socioeconomic Status and Sociodemographic Features on Cardiovascular Disease. Mortality and Morbidity in Finland. 2013.
Boersma E, Pieper KS, Steyerberg EW, Wilcox RG, Chang W-C, Lee KL, et al. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation results from an international trial of 9461 patients. Circulation. 2000;101:2557-67.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Circulation. 2012;126:2020-35.
Schwamm LH, Ali SF, Reeves MJ, Smith EE, Saver JL, Messe S, et al. Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines–Stroke hospitals. Circulation: Cardiovascular Quality and Outcomes. 2013;6:543-9.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2013;62:e147-e239.
Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials a consensus report from the bleeding academic research consortium. Circulation. 2011;123:2736-47.
Das B, Mishra TK. Prevention and Management of Arrhythmias in Acute Myocardial Infarction. International Journal of Contemporary Medical Research.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015;28:1-39. e14.
El-Gilany A, Elkhawaga G. Socioeconomic determinants of eating pattern of adolescent students in Mansoura, Egypt. The Pan African Medical Journal. 2012;13:22.
Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease. European heart journal. 2013;34:2949-3003.
Stirbu I, Looman C, Nijhof GJ, Reulings PG, Mackenbach JP. Income inequalities in case death of ischaemic heart disease in the Netherlands: a national record-linked study. Journal of epidemiology and community health. 2012;66:1159-66.
Mansyur C, Amick BC, Harrist RB, Franzini L. Social capital, income inequality, and self-rated health in 45 countries. Social science & medicine. 2008;66:43-56.
Case A. Does money protect health status? Evidence from South African pensions. Perspectives on the Economics of Aging: University of Chicago Press; 2004. p. 287-312.
Davies CA, Dundas R, Leyland AH. Increasing socioeconomic inequalities in first acute myocardial infarction in Scotland, 1990–92 and 2000–02. BMC Public Health. 2009;9:1.
Ljung R, Peterson S, Hallqvist J, Heimerson I, Diderichsen F. Socioeconomic differences in the burden of disease in Sweden. Bulletin of the World Health Organization. 2005;83:92-9.
Gerber Y, Benyamini Y, Goldbourt U, Drory Y, Infarction ISGoFAM. Neighborhood socioeconomic context and long-term survival after myocardial infarction. Circulation. 2010;121:375-83.
Danchin N, Neumann A, Tuppin P, De Peretti C, Weill A, Ricordeau P, et al. Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction An Analysis From the French National Health Insurance System. Circulation: Cardiovascular Quality and Outcomes. 2011;4:619-25.
Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. American journal of public health. 1992;82:816-20.
Welch CA, Harrison DA, Hutchings A, Rowan K. The association between deprivation and hospital mortality for admissions to critical care units in England. Journal of critical care. 2010;25:382-90.
Hutchings A, Raine R, Brady A, Wildman M, Rowan K. Socioeconomic status and outcome from intensive care in England and Wales. Medical care. 2004;42:943-51.
Ciccone G, Lorenzoni L, Ivaldi C, Ciccarelli E, Piobbici M, Arione R. [Social class, mode of admission, severity of illness and hospital mortality: an analysis with" All patient refined DRG" of discharges from the Molinette hospital in Turin]. Epidemiologia e prevenzione. 1998;23:188-96.
Pilote L, Tu JV, Humphries K, Behouli H, Belisle P, Austin PC, et al. Socioeconomic status, access to health care, and outcomes after acute myocardial infarction in Canada's universal health care system. Medical care. 2007;45:638-46.
O'Gara PT, Kushner F, Ascheim D. ACCF/AHA Guideline. Circulation. 2013;127:529-55.
Fabreau GE, Leung AA, Southern DA, Knudtson ML, McWilliams JM, Ayanian JZ, et al. Sex, socioeconomic status, access to cardiac catheterization, and outcomes for acute coronary syndromes in the context of universal healthcare coverage. Circulation: Cardiovascular Quality and Outcomes. 2014;7:540-9.
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction. Jama. 2010;303:1392-400.
Chang W-C, Kaul P, Westerhout CM, Graham MM, Armstrong PW. Effects of socioeconomic status on mortality after acute myocardial infarction. The American journal of medicine. 2007;120:33-9.
Livesey S. Socio-economic deprivation and outcome in patients with coronary artery disease. Heart. 2009;95:785-6.
Leyland AH, Dundas R, McLoone P, Boddy FA. Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study. BMC Public Health. 2007;7:1.
Hawkins NM, Jhund PS, McMurray JJ, Capewell S. Heart failure and socioeconomic status: accumulating evidence of inequality. European journal of heart failure. 2012;14:138-46.
He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Archives of internal medicine. 2001;161:996-1002.
Keeley E, Boura J, Grines C. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13-20.
Popović AD, Nesković A, Pavlovski K, Marinković J, Babić R, Bojić M, et al. Association of ventricular arrhythmias with left ventricular remodelling after myocardial infarction. Heart. 1997;77:423-7.
Tansey M, Opie L. Relation between plasma free fatty acids and arrhythmias within the first twelve hours of acute myocardial infarction. The Lancet. 1983;322:419-22.