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The impact of low income on long-term mortality of myocardial infarction patients: results from the Brazilian Heart Study

Low socioeconomic status has for long been considered an important modifiable risk factor for developing cardiovascular disease, plausibly by lower access to healthcare, lower therapeutic adhesion, and overlapping of other known risk factors. Nevertheless, whether family income and social isolation... Full description

Journal Title: Current medical research and opinion 2021, Vol.37 (10), p.1689-1695
Main Author: Barreto, Joaquim
Other Authors: Matos, Luís Carlos V. , Quinaglia, José Carlos , Sposito, Andrei C. , Carvalho, Luiz Sergio
Format: Electronic Article Electronic Article
Language: English
Subjects:
acute coronary syndrome
Acute myocardial infarction
coronary artery disease
family income
socioeconomic
Quelle: Alma/SFX Local Collection
Publisher: Taylor & Francis
ID: ISSN: 0300-7995
Zum Text:
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recordid: cdi_crossref_primary_10_1080_03007995_2021_1965561
title: The impact of low income on long-term mortality of myocardial infarction patients: results from the Brazilian Heart Study
format: Article
creator:
  • Barreto, Joaquim
  • Matos, Luís Carlos V.
  • Quinaglia, José Carlos
  • Sposito, Andrei C.
  • Carvalho, Luiz Sergio
subjects:
  • acute coronary syndrome
  • Acute myocardial infarction
  • coronary artery disease
  • family income
  • socioeconomic
ispartof: Current medical research and opinion, 2021, Vol.37 (10), p.1689-1695
description: Low socioeconomic status has for long been considered an important modifiable risk factor for developing cardiovascular disease, plausibly by lower access to healthcare, lower therapeutic adhesion, and overlapping of other known risk factors. Nevertheless, whether family income and social isolation of poor communities seen in Brazil impact outcomes following ST-segment elevation myocardial infarction (STEMI) remain scarcely understood. STEMI diagnosed patients were consecutively enrolled from the Brazilian Heart Study (ClinicalTrials.gov Identifier: NCT02062554) and categorized according to median family income (US$350), address-based human development index (HDI), and distance between communities and a tertiary hospital (DCTH). Incidence of death after 48 months was compared by using adjusted Cox regressions. p-alues 
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0300-7995
fulltext: fulltext
issn:
  • 0300-7995
  • 1473-4877
url: Link


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descriptionLow socioeconomic status has for long been considered an important modifiable risk factor for developing cardiovascular disease, plausibly by lower access to healthcare, lower therapeutic adhesion, and overlapping of other known risk factors. Nevertheless, whether family income and social isolation of poor communities seen in Brazil impact outcomes following ST-segment elevation myocardial infarction (STEMI) remain scarcely understood. STEMI diagnosed patients were consecutively enrolled from the Brazilian Heart Study (ClinicalTrials.gov Identifier: NCT02062554) and categorized according to median family income (US$350), address-based human development index (HDI), and distance between communities and a tertiary hospital (DCTH). Incidence of death after 48 months was compared by using adjusted Cox regressions. p-alues < .05 were considered significant. Among 542 subjects, there were 69 deaths (13.2%) after a median follow-up time of 611 d (IQR = 724). The low-income group had a higher incidence of all-cause mortality compared to high income (18.4 vs. 7.1%; p = .001), with an adjusted HR of 2.16 (95%CI: 1.25-3.75; p = .006). Compared to high-income, low-income individuals had the worst clinical presentation of myocardial infarction and less frequently received dual antiplatelet therapy and statins at hospital discharge. The population attributable risk of low income was 44.8%. HDI and DCTH did not influence the delay to reperfusion therapy nor the risk of death. Low income was independently associated with a higher long-term mortality rate, lower prescription of guidelines-recommended therapy, and worst clinical presentation of myocardial infarction in STEMI patients.
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abstractLow socioeconomic status has for long been considered an important modifiable risk factor for developing cardiovascular disease, plausibly by lower access to healthcare, lower therapeutic adhesion, and overlapping of other known risk factors. Nevertheless, whether family income and social isolation of poor communities seen in Brazil impact outcomes following ST-segment elevation myocardial infarction (STEMI) remain scarcely understood. STEMI diagnosed patients were consecutively enrolled from the Brazilian Heart Study (ClinicalTrials.gov Identifier: NCT02062554) and categorized according to median family income (US$350), address-based human development index (HDI), and distance between communities and a tertiary hospital (DCTH). Incidence of death after 48 months was compared by using adjusted Cox regressions. p-alues < .05 were considered significant. Among 542 subjects, there were 69 deaths (13.2%) after a median follow-up time of 611 d (IQR = 724). The low-income group had a higher incidence of all-cause mortality compared to high income (18.4 vs. 7.1%; p = .001), with an adjusted HR of 2.16 (95%CI: 1.25-3.75; p = .006). Compared to high-income, low-income individuals had the worst clinical presentation of myocardial infarction and less frequently received dual antiplatelet therapy and statins at hospital discharge. The population attributable risk of low income was 44.8%. HDI and DCTH did not influence the delay to reperfusion therapy nor the risk of death. Low income was independently associated with a higher long-term mortality rate, lower prescription of guidelines-recommended therapy, and worst clinical presentation of myocardial infarction in STEMI patients.
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