O002 Roadmap to 25x25: A Systematic Review of the Effectiveness and Cost-Effectiveness of Interventions to Improve Adherence to Cardiovascular Medications in Low- and Middle-Income Countries

Abstract

Introduction: Delay in access from firstmedical contact (systemdelay), resulting in increased symptom to balloon time (STBT), affects outcomes in primary PCI. Guidelines recommend a door-to-balloon-time (DTBT) of 90minutes and now suggest a first medical contact to door time of 30 minutes. Socioeconomic status (SES), including area of residence, has been shown to impact on symptom to door time (STDT) in the USA and New Zealand. Objectives: We evaluated whether area of residence impacts on pre-hospital delay utilising a large multicenter registry. Methods: We identified 3205 consecutive patients undergoing primary PCI from the Melbourne Interventional Group registry between 2005-2011. Patients were categorised by SES derived from patient postcode using the Socio-Economic Indexes for Areas compiled by the Australian Bureau of Statistics. Patients were divided into quintiles; the most disadvantaged as Quintile 1 and the least disadvantaged asQuintile 5. Baselinedata, STEMI timings andoutcomes were described as a function of socioeconomic quintile, using the non-parametric trend test. Results: Those who were least disadvantaged were older, with lower BMI. Those who were more disadvantaged were more likely to have diabetes, hyperlipidaemia, and a previous MI. There were no other differences in baseline characteristics between the quintiles, including gender. Patients of lower SES were more likely to initially present to a non-PCI capable hospital and, when transferred for PCI, had significantly longer transfer times. Conclusion: Lower SES is correlated with increased symptom to door time, and hence