Abstract
ObjectivesTo examine the relationship between socio-economic status (SES), functional recovery and long-term mortality following acute myocardial infarction (AMI).BackgroundThe extent to which SES mortality disparities are explained by differences in functional recovery following AMI is unclear.MethodsWe prospectively examined 1368 patients who survived at least one-year following an index AMI between 1999 and 2003 in Ontario, Canada. Each patient was linked to administrative data and followed over 9.6 years to track mortality. All patients underwent medical chart abstraction and telephone interviews following AMI to identify individual-level SES, clinical factors, processes of care (i.e., use of, and adherence, to evidence-based medications, physician visits, invasive cardiac procedures, referrals to cardiac rehabilitation), as well as changes in psychosocial stressors, quality of life, and self-reported functional capacity.ResultsAs compared with their lower SES counterparts, higher SES patients experienced greater functional recovery (1.80 ml/kg/min average increase in peak V02, P<0.001) after adjusting for all baseline clinical factors. Post-AMI functional recovery was the strongest modifiable predictor of long-term mortality (Adjusted HR for each ml/kg/min increase in functional capacity: 0.91; 95% CI: 0.87–0.94, P<0.001) irrespective of SES (P = 0.51 for interaction between SES, functional recovery, and mortality). SES-mortality associations were attenuated by 27% after adjustments for functional recovery, rendering the residual SES-mortality association no longer statistically significant (Adjusted HR: 0.84; 95% CI:0.70–1.00, P = 0.05). The effects of functional recovery on SES-mortality associations were not explained by access inequities to physician specialists or cardiac rehabilitation.ConclusionsFunctional recovery may play an important role in explaining SES-mortality gradients following AMI.
Highlights
Post-acute myocardial infarction (AMI) functional recovery was the strongest modifiable predictor of long-term mortality (Adjusted HR for each ml/kg/min increase in functional capacity: 0.91; 95% CI: 0.87–0.94, P,0.001) irrespective of Socioeconomic status (SES) (P = 0.51 for interaction between SES, functional recovery, and mortality)
SES-mortality associations were attenuated by 27% after adjustments for functional recovery, rendering the residual SES-mortality association no longer statistically significant (Adjusted HR: 0.84; 95% CI:0.70–1.00, P = 0.05)
The effects of functional recovery on SES-mortality associations were not explained by access inequities to physician specialists or cardiac rehabilitation
Summary
[15,16,17] one may reasonably hypothesize that socioeconomic disparities in functional capacity recovery may exist after AMI, and that such disparities may help explain why lower SES patients experience higher long-term mortality after AMI [18,19]. The objective of our study was to examine the relationship between SES, self-reported functional recovery, and long-term survival following AMI. We hypothesized that differences in access to secondary prevention service delivery may help explain SES-differences in self-reported functional recovery, and may partially account for long-term SES-mortality associations through changes in functional capacity among AMI survivors [20]. The extent to which SES mortality disparities are explained by differences in functional recovery following AMI is unclear
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