Outcomes, care of cardiogenic shock poorer among patients of lower socioeconomic status
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Lower socioeconomic status was associated with increased risk for cardiogenic shock, decreased likelihood of transfer to cardiac catheterization and increased odds of 30-day all-cause death, researchers reported.
Patients with the lowest quintile of socioeconomic status and cardiogenic shock had a nearly 40% greater risk for 30-day all-cause mortality compared with those with the highest socioeconomic status, according to the study published in European Heart Journal – Quality of Care and Clinical Outcomes.
“We aimed to evaluate the significance of socioeconomic status within a framework of universal health care, as exists in Australia. Whereas much of the current literature examines the impact of low socioeconomic status in a mixed health care system combining publicly and privately funded coverage (such as the U.S.), access to hospital care in Australia is readily financed through Medicare, a taxpayer-funded health care system delivered with no out-of-pocket costs,” Jason E. Bloom, MBBS, of the department of cardiology at Alfred Health in Melbourne, Australia, and colleagues wrote. “By removing the confounding of potential inequalities in access to health care, we aimed to draw more significant associations between socioeconomic status and any observed disparities in care metrics and outcomes in patients presenting with cardiogenic shock.”
This study included 2,628 consecutive patients with cardiogenic shock transported via emergency medical services (EMS) in Victoria, Australia, and the researchers used individually linked ambulance, hospital and mortality datasets to evaluate the impact of socioeconomic status on cardiogenic shock outcomes.
Bloom and colleagues used national census data from the Australian Bureau of Statistics to stratify patients into quintiles of socioeconomic status.
Care varies by socioeconomic status
The age-standardized incidence of cardiogenic shock among all participants was 11.8 per 100,000 person-years (95% CI, 11.4-12.3), and researchers observed an increase in cardiogenic shock incidence among patients in the lowest quintile of socioeconomic status compared with those in the highest quintile (17 vs. 9.7 per 100,000 person-years; P for trend < .001).
Compared with patients in the highest socioeconomic quintile, patients in the lowest quintile were less likely to be transported to metropolitan hospitals (16.6% vs. 25.7%; P for trend < .001) and were more likely to go to inner regional and remote centers without revascularization capabilities (39% vs. 4.4%; P for trend < .001).
Patients in the lowest quintile were more likely to die in ED (14.5% vs. 7.5%; P for trend = .02) and were less likely to be transferred directly to cardiac catheterization (16.3% vs. 25.8%; P for trend = .02) to undergo left heart catheterization (28% vs. 38.9%; P for trend = .008) or to undergo PCI (13.7% vs. 18.7%; P for trend = .006) compared with those in the highest quintile.
Risk for all-cause death varies by socioeconomic status
After multivariable adjustment, researchers observed increased risk for 30-day all-cause mortality in the lowest three quintiles of socioeconomic status compared with the highest quintile (HR for lowest quintile = 1.39; 95% CI, 1.1-1.7; P = .002; HR for second lowest quintile = 1.36; 95% CI, 1.1-1.7; P = .005; HR for third lowest quintile = 1.27; 1.02-1.6; P = .03).
“In this statewide, population-based study ... age-standardized incidence of cardiogenic shock was disproportionately higher in those from lower socioeconomic status brackets,” the researchers wrote. “Lower socioeconomic status quintiles were less aggressively investigated and managed with coronary angiography, and had a greater 30-day all-cause mortality rate. These findings emphasize the need to acknowledge this at-risk cohort of patients, and reinforce the importance of policymaking in addressing upstream discrepancies in the delivery of health care to mitigate this risk.”
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Bloom JE, et al. Eur Heart J Qual Care Clin Outcomes. 2023;doi:10.1093/ehjqcco/qcad010/7044772.
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