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HF after MI less likely among patients with higher education
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Among patients hospitalized for a first acute MI, there was an inverse association between level of education and early or late onset of HF, according to new findings.
Researchers conducted a retrospective cohort study of 70,506 patients without prior documentation of HF hospitalized in Norway for a first acute MI between 2001 and 2009. They stratified patients by level of education (primary, secondary or tertiary) and analyzed the association between education level and risk for HF.
“Previous research has shown that patients are more likely to die after [MI] if they have a lower educational level, but information on the mechanisms involved is sparse,” Gerhard Sulo, MD, PhD, postdoctoral fellow at the University of Bergen, Norway, said in a press release. “[HF] is the most important incident in the chain of events leading to death after [MI], and we hypothesized that it might contribute to the observed educational disparities in survival.”
Gerhard Sulo
Sulo and colleagues found that 17.7% of the cohort had HF at admission or developed it during hospitalization for MI.
Compared with those with primary education, those with secondary education had reduced risk for early-onset HF (incidence rate ratio = 0.91; 95% CI, 0.87-0.94), as did those with tertiary education (incidence rate ratio = 0.8; 95% CI, 0.75-0.86), according to the researchers.
The researchers also analyzed subsequent outcomes of the 54,095 patients who were discharged alive without HF. During a median follow-up of 3.4 years, 11.8% of that cohort died of late-onset HF or were hospitalized for it.
Those with secondary education had lower risk for late-onset HF than those with primary education (HR = 0.86; 95% CI, 0.82-0.91), as did those with tertiary education (HR = 0.73; 95% CI, 0.66-0.8), Sulo and colleagues reported.
Educational differences in HF risk did not differ by sex (P for interaction = .7), according to the researchers.
“Education per se cannot be considered a ‘protective exposure’ in the classical sense but represents a clustering of characteristics that influence health behaviors and outcomes,” Sulo said in the release. “It has been shown that patients with lower education tend to delay seeking medical care when [MI] symptoms occur and they have poorer access to specialized care. Both of these factors increase the risk of developing early-onset [HF] after [acute MI]. Those with lower education are more likely to have coexisting medical conditions and unhealthy lifestyles, which also increase the risk [for HF]. Patients with lower education are less likely to be prescribed medication after [MI] to prevent [HF], and they are also less likely to take their medication. This may explain the increased risk of late-onset [HF].” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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