Abstract
Introduction: Social determinants of health have an established impact on cardiovascular outcomes. STEMI quality improvement programs have resulted in reductions in door to balloon time (D2BT) and improved STEMI outcomes nationally. We evaluated whether a comprehensive STEMI protocol (CSP) improves care and outcomes in patients with moderate and high socioeconomic deprivation. Methods: Patients with STEMI treated with PCI at a single tertiary care hospital before (1/1/11-7/14/14, n=674) and after (7/15/14-7/15/19, n=1087) implementation of a CSP were included. Patients were stratified into low ( < 50 th percentile), medium (51-90 th percentile), and high (>90 th percentile) deprivation groups based on census block group level area deprivation index. Outcomes were D2BT and mortality. Results: Neighborhood deprivation was 29.0% low (174 pre-CSP, 338 post-CSP), 40.8% moderate (268 pre, 450 post), and 30.2% high (232 pre, 299 post). Female sex (low 28.3%, moderate 31.9%, high 38.6%, p=0.001) and black race (2.5%, 20.7%, 61.8%, p<0.001) were associated with higher levels of deprivation. Improvements in median D2BT were observed in all deprivation groups after CSP implementation (Figure). Risk-adjusted median D2BT among ER/hospital patients from higher neighborhood deprivation levels was significantly non-inferior (non-inferiority limit = 5m) to those from lower deprivation levels after CSP implementation. In-hospital mortality was similar before and after CSP implementation in the low deprivation group (4.6% vs. 3.6%, p=0.56), and decreased significantly in moderate/high deprivation groups (7.0% vs. 3.1%, p=0.001). Conclusions: A CSP was associated with improvements in D2BT across all deprivation groups and a substantial mortality reduction in moderate/high deprivation groups. Standardized quality improvement initiatives may mitigate social determinants of health in time-sensitive high acuity conditions such as STEMI.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
