Socioeconomic Equity in the Receipt of In-Hospital Care and Outcomes in Australian Acute Coronary Syndrome Patients: The CONCORDANCE Registry

Karice Hyun, Julie Redfern, Mark Woodward, Mario D'Souza, Pratap Shetty, Derek Chew, Nadarajah Kangaharan, Ahmad Farshid, Kevin Alford, Tom Briffa, David Brieger

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    Abstract

    Background

    Socioeconomic status (SES) is a social determinant of both health and receipt of health care services, but its impact is under-studied in acute coronary syndrome (ACS). The aim of this study was to examine the influence of SES on in-hospital care, and clinical events for patients presenting with an ACS to public hospitals in Australia.

    Methods

    Data from 9064 ACS patient records were collected from 41 public hospitals nationwide from 2009 as part of the Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) registry. For this analysis, we divided the cohort into four socioeconomic groups (based on postcode of usual residence) and compared the in-hospital care provided and clinical outcomes before and after adjustment for both patient clinical characteristics and hospital clustering.

    Results

    Patients were divided into four SES groups (from the most to the least disadvantaged: 2042 (23%) vs. 2104 (23%) vs. 1994 (22%) vs. 2968 (32%)). Following adjustments for patient characteristics, there were no differences in the odds of receiving coronary angiogram, revascularisation, prescription of recommended medication, or referral to cardiac rehabilitation across the SES groups (p = 0.06, 0.69, 0.89 and 0.79, respectively). After adjustment for clinical characteristics, no associations were observed for in-hospital and cumulative death (p = 0.62 and p = 0.71, respectively).

    However, the most disadvantaged group were 37% more likely to have a major adverse cardiovascular event (MACE) than the least disadvantaged group (OR (95% CI): 1.37 (1.1, 1.71), p = 0.02) driven by incidence of in-hospital heart failure.

    Conclusions

    Although there may be gaps in the delivery of care, this delivery of care does not differ by patient's SES. It is an encouraging affirmation that all patients in Australian public hospitals receive equal in-hospital care, and the likelihood of death is comparable between the SES groups.

    Original languageEnglish
    Pages (from-to)1398-1405
    Number of pages8
    JournalHeart, Lung and Circulation
    Volume27
    Issue number12
    DOIs
    Publication statusPublished - Dec 2018

    Keywords

    • Acute coronary syndrome
    • Socioeconomic status
    • In-Hospital care
    • Clinical events

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  • Cite this

    Hyun, K., Redfern, J., Woodward, M., D'Souza, M., Shetty, P., Chew, D., Kangaharan, N., Farshid, A., Alford, K., Briffa, T., & Brieger, D. (2018). Socioeconomic Equity in the Receipt of In-Hospital Care and Outcomes in Australian Acute Coronary Syndrome Patients: The CONCORDANCE Registry. Heart, Lung and Circulation, 27(12), 1398-1405. https://doi.org/10.1016/j.hlc.2017.08.019