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Title: Socioeconomic Equity in the Receipt of In-Hospital Care and Outcomes in Australian Acute Coronary Syndrome Patients: The CONCORDANCE Registry.
Authors: Hyun, Karice
Redfern, Julie
Woodward, Mark
D'Souza, Mario
Shetty, Pratap
Chew, Derek
Kangaharan, Nadarajah
Farshid, Ahmad
Alford, Kevin
Briffa, Tom
Brieger, David
Affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia; ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, NSW, Australia. Electronic address:
The George Institute for Global Health, Sydney, NSW, Australia..
The George Institute for Global Health, Sydney, NSW, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK..
Sydney Local Health District Clinical Research Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia..
Department of Cardiology, Wollongong Hospital, Wollongong, NSW, Australia..
Department of Cardiology, Flinders University, Adelaide, SA, Australia..
Department of Cardiology, Alice Springs Hospital, Alice Springs, NT, Australia..
Department of Cardiology, Canberra Hospital, Canberra, ACT, Australia..
Department of Cardiology, Port Macquarie Hospital, Port Macquarie, NSW, Australia..
School of Population Health, University of Western Australia, Perth, WA, Australia..
Department of Cardiology, Concord Hospital, University of Sydney, Sydney, NSW, Australia..
Issue Date: Dec-2018
Citation: Heart, lung & circulation 2018-12; 27(12): 1398-1405
Abstract: Socioeconomic status (SES) is a social determinant of both health and receipt of health care services, but its impact is under-studied in acute coronary syndrome (ACS). The aim of this study was to examine the influence of SES on in-hospital care, and clinical events for patients presenting with an ACS to public hospitals in Australia. Data from 9064 ACS patient records were collected from 41 public hospitals nationwide from 2009 as part of the Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) registry. For this analysis, we divided the cohort into four socioeconomic groups (based on postcode of usual residence) and compared the in-hospital care provided and clinical outcomes before and after adjustment for both patient clinical characteristics and hospital clustering. Patients were divided into four SES groups (from the most to the least disadvantaged: 2042 (23%) vs. 2104 (23%) vs. 1994 (22%) vs. 2968 (32%)). Following adjustments for patient characteristics, there were no differences in the odds of receiving coronary angiogram, revascularisation, prescription of recommended medication, or referral to cardiac rehabilitation across the SES groups (p=0.06, 0.69, 0.89 and 0.79, respectively). After adjustment for clinical characteristics, no associations were observed for in-hospital and cumulative death (p=0.62 and p=0.71, respectively). However, the most disadvantaged group were 37% more likely to have a major adverse cardiovascular event (MACE) than the least disadvantaged group (OR (95% CI): 1.37 (1.1, 1.71), p=0.02) driven by incidence of in-hospital heart failure. Although there may be gaps in the delivery of care, this delivery of care does not differ by patient's SES. It is an encouraging affirmation that all patients in Australian public hospitals receive equal in-hospital care, and the likelihood of death is comparable between the SES groups.
DOI: 10.1016/j.hlc.2017.08.019
Type: Journal Article
Multicenter Study
Subjects: Acute coronary syndrome
Clinical events
In-Hospital care
Socioeconomic status
Acute Coronary Syndrome
Coronary Angiography
Delivery of Health Care
Hospital Mortality
Hospitals, Public
Middle Aged
Risk Factors
Socioeconomic Factors
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