Income is associated with the probability to receive early coronary angiography after out-of-hospital cardiac arrest

Rickard Lagedal,Martin Jonsson,Ludvig Elfwén,David Smekal,Per Nordberg,Stefan James,Sten Rubertsson

doi:10.1016/j.resuscitation.2020.08.016

Rickard Lagedal, Martin Jonsson + Show 5 more

Open Access

https://doi.org/10.1016/j.resuscitation.2020.08.016

Copy DOI

Abstract

IntroductionLow socioeconomic status has been associated with worse outcome after cardiac arrest. This study aims to investigate if patients´ income influences the probability to receive early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients. MethodsIn this nationwide retrospective observational study, 3906 OHCA patients admitted alive and registered in the Swedish Registry for Cardiopulmonary Resuscitation were included. Individual data on income and educational level, prehospital parameters, coronary angiography results and comorbidity were linked from SWEDEHEART and other national registers. ResultsPatients were divided into quarters depending on their income level. In the unadjusted model there was a strong correlation between income level and rate of early coronary angiography where 35.5% of patients in the highest income quarters received early angiography compared to 15.4% in the lowest income quarters. When adjusting for educational level, sex, age, comorbidity and hospital type, there were still higher chance of receiving early coronary angiography with increasing income, OR 1.31 (CI 1.01–1.68) and 1.67 (CI 1.29–2.16) for the two highest income quarters respectively compared to the lowest income quarter. When adding potential mediators to the model (first recorded ECG rhythm by the EMS, location, response time, bystander cardiopulmonary resuscitation and if the arrest was witnessed) no difference in early angiography related to income level where found. The main mediator was first recorded ECG rhythm. ConclusionIncome level is associated with the probability to undergo early coronary angiography in OHCA patients. This association seems to be mediated by the initial ECG rhythm.

Highlights

Low socioeconomic status has been associated with worse outcome after cardiac arrest
Others measures performed after return of spontaneous circulation (ROSC), e.g. target temperature management (TTM) and the role of coronary angiography in patients without ST-elevation are still unclear.[1,2]
Data on all patients admitted alive and registered in the Swedish Registry for Cardiopulmonary Resuscitation during 2008À2013 were retrieved. These were merged with the SWEDEHEART registry (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) containing both coronary angiography data and information on presenting electrocardiogram (ECG)

Summary

Introduction

Low socioeconomic status has been associated with worse outcome after cardiac arrest. Conclusion: Income level is associated with the probability to undergo early coronary angiography in OHCA patients This association seems to be mediated by the initial ECG rhythm. The pattern of association between socioeconomic status and outcome is described in other of intensive care diagnoses, such as sepsis.[5] Studies from other medical fields than intensive care have shown that socioeconomic factors might influence the chance to receive certain treatments or interventions, even in publicly financed health care systems.[6,7] the access and time to coronary angiography after myocardial infarction without the complication of a cardiac arrest has been shown to be influenced by income and educational level in some studies.[8]

Objectives

Methods

Results

Conclusion