Abstract
BackgroundPatients living under better socioeconomic circumstances often receive more active treatments after an acute myocardial infarction (AMI) compared to less affluent patients. However, most previous studies were performed in countries with less comprehensive coverage for medical services. In this Swedish nation-wide longitudinal study we wanted to evaluate long-term survival after AMI in relation to socioeconomic position (SEP) and use of revascularization.MethodsFrom the Swedish Myocardial Infarction Register we identified all 45 to 84-year-old patients (16,041 women and 30,366 men) alive 28 days after their first AMI during the period 1993 to 1996. We obtained detailed information on the use of revascularization, cumulative household income from the 1975 and 1990 censuses and 5-year survival after the AMI.ResultsPatients with the highest cumulative income (adding the values of the quartile categories of income in 1975 and 1990) underwent a revascularization procedure within one month after their first AMI two to three times as often as patients with the lowest cumulative income and had half the risk of death within five years. The socioeconomic differences in the use of revascularization procedures could not be explained by differences in co-morbidity or type of hospital at first admission. Patients who underwent revascularization showed a similar lowered mortality risk in the different income groups, while there were strong socioeconomic differences in long-term mortality among patients who did not undergo revascularization.ConclusionThis nationwide Swedish study showed that patients with high income had a better long-term survival after recovery from their AMI compared to patients with low income. Furthermore, even though the use of revascularization procedures is beneficial, low SEP groups receive it less often than high SEP groups.
Highlights
Patients living under better socioeconomic circumstances often receive more active treatments after an acute myocardial infarction (AMI) compared to less affluent patients
Procedures such as invasive cardiac revascularization, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG), have been shown to increase survival [13,14,15] and there is some epidemiological evidence indicating that socioeconomic differences in survival after AMI is affected by differences in access and quality of hospital care [16]
1014 (3.3%) men and 357 (2.2%) women received a coronary revascularization within one month after their first AMI
Summary
Patients living under better socioeconomic circumstances often receive more active treatments after an acute myocardial infarction (AMI) compared to less affluent patients. During the last 20 years the role of risk factors (i.e., smoking, cholesterol and hypertension) in explaining the increase in survival after an AMI has decreased [10,11] This is more pronounced in individuals in high socioeconomic position (SEP) and has been suggested to be partly attributed to greater benefits from treatment such as thrombolysis and revascularization procedures in this group [10,11]. The disability associated with heart failure after an AMI is largely a consequence of infarct size, and lack of timely treatment is a major determinant of increased infarct size [12] Procedures such as invasive cardiac revascularization, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG), have been shown to increase survival [13,14,15] and there is some epidemiological evidence indicating that socioeconomic differences in survival after AMI is affected by differences in access and quality of hospital care [16]
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