Erschienen in:
10.12.2015 | Original Paper
Impact of income status on prognosis of acute coronary syndrome patients during Greek financial crisis
verfasst von:
George Andrikopoulos, Stylianos Tzeis, Dimitrios Terentes-Printzios, Christos Varounis, Charalampos Vlachopoulos, Ioannis Mantas, Sotirios Patsilinakos, Stylianos Lampropoulos, Christoforos Olympios, Athanasios Kartalis, Athanasios Manolis, Alexandros Gotsis, Filippos Triposkiadis, Themistoklis Tsaknakis, Ioannis Goudevenos, Ioannis Kaprinis, Athanasios Pras, Fotios Vasiliou, Emmanouil Skoumpourdis, Gerasimoula Sakka, Antonios Draganigos, Panos Vardas
Erschienen in:
Clinical Research in Cardiology
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Ausgabe 6/2016
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Abstract
Background
The effect of income status on patient outcome merits investigation during periods of financial crisis. We evaluated the impact of income status on out-of-hospital prognosis in a cohort of acute coronary syndrome (ACS) patients, included in a countrywide study during a period of financial crisis.
Methods
The study is a secondary analysis of a prospective, multicenter, observational study–the PHAETHON study—enrolling consecutive ACS patients in 37 hospitals in Greece. Patients were classified as low or high income based on the reported net annual household income using as a cut-off point the relative poverty threshold for Greece of 12,000 Euros. The outcome measure was survival free of the primary composite endpoint (cardiovascular death, myocardial infarction, stroke/transient ischemic attack, urgent revascularization and urgent hospitalization due to cardiovascular causes).
Results
The study population included 794 patients. The administration rate of evidence-based medications was similar in the low- (n = 455) and high-income (n = 339) groups during hospitalization and upon discharge. In a median follow-up of 189 days (interquartile range: 180–212 days), low-income patients had 92 % higher risk of the combined endpoint as compared to high-income patients [Hazard ratio (HR):1.92, 95 % CI:1.25–2.94, p = 0.003]. The effect of low-income status on the combined outcome remained significant after adjustment for age, gender and depression (HR:1.59, 95 % CI:1.02–2.49; p = 0.043).
Conclusions
In a period of financial crisis, low income is a significant and independent predictor of poor out-of-hospital outcome in ACS patients. This association has profound implications and should be taken into consideration by public health policy makers.