Treatment patterns, outcomes vary by income of elderly post-heart attack patients

important point:

• Adjusted 30-day and 1-year mortality after MI were higher in older low-income and high-income patients.
• Cardiac catheterization and PCI rates after MI were lower in low-income patients.

An analysis of administrative claims data across six high-income countries shows that income disparities in treatment and outcomes for older adults persist after treatment. sharpieincluding countries with universal health insurance.

In a continuous cross-sectional analysis of more than 1.1 million adults aged 65 years and older who were hospitalized with acute myocardial infarction from the United States, Canada, United Kingdom, Israel, the Netherlands, and Taiwan, the investigators determined the adjusted 30-day and 1-year mortality rates. After the rate is high MI Comparison of low- and high-income earnerswhereas rates of cardiac catheterization and PCI were low.

“The conventional wisdom is that the U.S. health care system is the most unfair and provides the most unfair care.” Bruce E. Landon, MD, MBA, He is a professor of health policy at Harvard Medical School and an internist and professor of internal medicine at Beth Israel Deaconess Medical Center, he tells Helio. “This study, which separates care patterns and outcomes for patients presenting at the same time of illness, actually found that care patterns and outcomes were worse for nearly all patients compared to those with higher incomes. different countries we investigated.

Landon et al. used data from 289,376 hospitalized patients with STEMI and 843,046 adults (all 65 years and older) hospitalized with non-STEMI from 2013 to 2018 in the United States, Canada, United Kingdom, the Netherlands, Taiwan, and Israel. Analyzed. The researchers stratified the patient by her top and bottom quintiles of domestic and country income. The primary outcome was 30-day and his 1-year mortality. Secondary endpoints included rate of cardiac catheterization and revascularization, length of stay and readmission rate.

The survey results are jam.

Adjusted 30-day mortality was generally 1 to 3 percentage points lower in high-income patients. In the Netherlands, 30-day mortality among patients admitted for STEMI was 10.2% in high-income patients compared with 13.1% in low-income patients, -2.8 percentage points (95% CI, 4.1–1.5 ) was the difference.

Evaluating differences in STEMI 1-year mortality increased the differences, with the largest difference observed in Israel (16.2% vs. 25.3%; difference, 9.1 percentage points; 95% CI, 16.7 to –1.6).

In all six countries, rates of cardiac catheterization and PCI were higher in high-income and low-income groups, with absolute differences between 1 and 6 percentage points. In England, his post-STEMI cardiac catheterization and PCI rates in high- and low-income patients were 73.6% and 67.4%, respectively, with a difference of 6.1 percentage points (95% CI, 1.2–11). .

CABG rates were similar in low-income and high-income STEMI patients. However, her incidence of CABG in non-STEMI patients was generally 1-2 percentage points higher in high-income patients.

The 30-day readmission rate was 1-3% lower, according to the researchers, and hospital stays were generally 0.2-0.5 days shorter for high- and low-income patients, the researchers said.

The researchers say the U.S. results are “not outliers” when it comes to care and outcomes provided to low- and high-income elderly patients after acute myocardial infarction.

“There are clear differences in the rate of use of recommended treatments, which may contribute to the differences in results,” Landon told Helio. There is a need to monitor performance and performance regarding these care processes, and further research is needed to ‘unravel’ these findings nationally. To what extent are our findings guided by seeking care from different hospitals and the different care provided within hospitals?”

For more information:

Bruce E. Landon, MD, MBA, can be reached by [email protected]Twitter: @bruce_landon.