PMID- 25398888
OWN - NLM
STAT- MEDLINE
DCOM- 20151008
LR  - 20240322
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 3
IP  - 6
DP  - 2014 Nov 14
TI  - Socioeconomic inequalities in quality of care and outcomes among patients with 
      acute coronary syndrome in the modern era of drug eluting stents.
PG  - e001029
LID - 10.1161/JAHA.114.001029 [doi]
LID - e001029
AB  - BACKGROUND: The rapidly changing landscape of percutaneous coronary intervention 
      provides a unique model for examining disparities over time. Previous studies 
      have not examined socioeconomic inequalities in the current era of drug eluting 
      stents (DES). METHODS AND RESULTS: We analyzed 835 070 hospitalizations for acute 
      coronary syndrome (ACS) from the Healthcare Cost and Utilization Project across 
      all insurance types from 2008 to 2011, examining whether quality of care and 
      outcomes for patients with ACS differed by income (based on zip code of 
      residence) with adjustment for patient characteristics and clustering by 
      hospital. We found that lower-income patients were less likely to receive an 
      angiogram within 24 hours of a ST elevation myocardial infarction (STEMI) (69.5% 
      for IQ1 versus 73.7% for IQ4, P<0.0001, OR 0.79 [0.68 to 0.91]) or within 48 
      hours of a Non-STEMI (47.6% for IQ1 versus 51.8% for IQ4, P<0.0001, OR 0.86 [0.75 
      to 0.99]). Lower income was associated with less use of a DES (64.7% for IQ1 
      versus 71.2% for IQ4, P<0.0001, OR 0.83 [0.74 to 0.93]). However, no differences 
      were found for coronary artery bypass surgery. Among STEMI patients, lower-income 
      patients also had slightly increased adjusted mortality rates (10.8% for IQ1 
      versus 9.4% for IQ4, P<0.0001, OR 1.17 [1.11 to 1.25]). After further adjusting 
      for time to reperfusion among STEMI patients, mortality differences across income 
      groups decreased. CONCLUSIONS: For the most well accepted procedural treatments 
      for ACS, income inequalities have faded. However, such inequalities have 
      persisted for DES use, a relatively expensive and until recently, controversial 
      revascularization procedure. Differences in mortality are significantly 
      associated with differences in time to primary PCI, suggesting an important 
      target for understanding why these inequalities persist.
CI  - (c) 2014 The Authors. Published on behalf of the American Heart Association, Inc., 
      by Wiley Blackwell.
FAU - Yong, Celina M
AU  - Yong CM
AD  - Stanford University/Stanford Cardiovascular Institute, Palo Alto, CA (C.M.Y., 
      F.A., P.A.H.) VA Palo Alto Health Care System, Palo Alto, CA (C.M.Y., S.M.A., 
      P.A.H.).
FAU - Abnousi, Freddy
AU  - Abnousi F
AD  - Stanford University/Stanford Cardiovascular Institute, Palo Alto, CA (C.M.Y., 
      F.A., P.A.H.).
FAU - Asch, Steven M
AU  - Asch SM
AD  - VA Palo Alto Health Care System, Palo Alto, CA (C.M.Y., S.M.A., P.A.H.) Division 
      of General Medical Disciplines, Stanford University School of Medicine, Palo 
      Alto, CA (S.M.A.).
FAU - Heidenreich, Paul A
AU  - Heidenreich PA
AD  - Stanford University/Stanford Cardiovascular Institute, Palo Alto, CA (C.M.Y., 
      F.A., P.A.H.) VA Palo Alto Health Care System, Palo Alto, CA (C.M.Y., S.M.A., 
      P.A.H.).
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20141114
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
SB  - IM
MH  - Acute Coronary Syndrome/diagnosis/economics/mortality/*therapy
MH  - Aged
MH  - Aged, 80 and over
MH  - Coronary Angiography
MH  - *Drug-Eluting Stents/economics/standards/trends
MH  - Female
MH  - *Healthcare Disparities/economics/standards/trends
MH  - Humans
MH  - Income
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/economics/mortality/*therapy
MH  - *Outcome and Process Assessment, Health Care/economics/standards/trends
MH  - Percutaneous Coronary Intervention/adverse 
      effects/economics/*instrumentation/mortality/standards/trends
MH  - *Quality Indicators, Health Care/economics/standards/trends
MH  - Residence Characteristics
MH  - *Socioeconomic Factors
MH  - Time Factors
MH  - Time-to-Treatment
MH  - Treatment Outcome
MH  - United States
PMC - PMC4338689
OTO - NOTNLM
OT  - acute coronary syndrome
OT  - outcomes
OT  - quality
OT  - socioeconomic status
EDAT- 2014/11/16 06:00
MHDA- 2015/10/09 06:00
PMCR- 2014/12/01
CRDT- 2014/11/16 06:00
PHST- 2014/11/16 06:00 [entrez]
PHST- 2014/11/16 06:00 [pubmed]
PHST- 2015/10/09 06:00 [medline]
PHST- 2014/12/01 00:00 [pmc-release]
AID - jah3751 [pii]
AID - 10.1161/JAHA.114.001029 [doi]
PST - epublish
SO  - J Am Heart Assoc. 2014 Nov 14;3(6):e001029. doi: 10.1161/JAHA.114.001029.