TY - JOUR
T1 - Association of socioeconomic status in the incidence, quality-of-care metrics, and outcomes for patients with cardiogenic shock in a pre-hospital setting
AU - Bloom, Jason E.
AU - Wong, Nathan
AU - Nehme, Emily
AU - Dawson, Luke P.
AU - Ball, Jocasta
AU - Anderson, David
AU - Cox, Shelley
AU - Chan, William
AU - Kaye, David M.
AU - Stub, Dion
A2 - Nehme, Ziad
N1 - Funding Information:
D.S. is supported by the National Heart Foundation (NHF); the National Health and Medical Research Council (NHMRC) fellowships; and a NHMRC Investigator Grant. J.B. and L.D. are supported by NHF and NHMRC postgraduatescholarships. Z.N. is supported by an NHF fellowship. E.N. is supported by an NHMRC postgraduate scholarship. D.K. is supported by an NHMRC Investigator Grant.
Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Aims The relationship between lower socioeconomic status (SES) and poor cardiovascular outcomes is well described; however, there exists a paucity of data exploring this association in cardiogenic shock (CS). This study aimed to investigate whether any disparities exist between SES and the incidence, quality of care or outcomes of CS patients attended by emergency medical services (EMS). Methods and This population-based cohort study included consecutive patients transported by EMS with CS between 1 January 2015 results and 30 June 2019 in Victoria, Australia. Data were collected from individually linked ambulance, hospital, and mortality datasets. Patients were stratified into SES quintiles using national census data produced by the Australian Bureau of Statistics. A total of 2628 patients were attended by EMS for CS. The age-standardized incidence of CS amongst all patients was 11.8 [95% confidence interval (95% CI), 11.4–12.3] per 100 000 person-years, with a stepwise increase from the highest to lowest SES quintile (lowest quintile 17.0 vs. highest quintile 9.7 per 100 000 person-years, P-trend < 0.001). Patients in lower SES quintiles were less likely to attend metropolitan hospitals and more likely to be received by inner regional and remote centres without revascularization capabilities. A greater proportion of the lower SES groups presented with CS due to non-ST elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UAP), and overall were less likely to undergo coronary angiography. Multivariable analysis demonstrated an increased 30-day all-cause mortality rate in the lowest three SES quintiles when compared with the highest quintile. Conclusion This population-based study demonstrated discrepancies between SES status in the incidence, care metrics, and mortality rates of patients presenting to EMS with CS. These findings outline the challenges in equitable healthcare delivery within this cohort.
AB - Aims The relationship between lower socioeconomic status (SES) and poor cardiovascular outcomes is well described; however, there exists a paucity of data exploring this association in cardiogenic shock (CS). This study aimed to investigate whether any disparities exist between SES and the incidence, quality of care or outcomes of CS patients attended by emergency medical services (EMS). Methods and This population-based cohort study included consecutive patients transported by EMS with CS between 1 January 2015 results and 30 June 2019 in Victoria, Australia. Data were collected from individually linked ambulance, hospital, and mortality datasets. Patients were stratified into SES quintiles using national census data produced by the Australian Bureau of Statistics. A total of 2628 patients were attended by EMS for CS. The age-standardized incidence of CS amongst all patients was 11.8 [95% confidence interval (95% CI), 11.4–12.3] per 100 000 person-years, with a stepwise increase from the highest to lowest SES quintile (lowest quintile 17.0 vs. highest quintile 9.7 per 100 000 person-years, P-trend < 0.001). Patients in lower SES quintiles were less likely to attend metropolitan hospitals and more likely to be received by inner regional and remote centres without revascularization capabilities. A greater proportion of the lower SES groups presented with CS due to non-ST elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UAP), and overall were less likely to undergo coronary angiography. Multivariable analysis demonstrated an increased 30-day all-cause mortality rate in the lowest three SES quintiles when compared with the highest quintile. Conclusion This population-based study demonstrated discrepancies between SES status in the incidence, care metrics, and mortality rates of patients presenting to EMS with CS. These findings outline the challenges in equitable healthcare delivery within this cohort.
KW - Cardiogenic shock
KW - Disparities
KW - Emergency medical services
KW - EMS r Socioeconomic status
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=85182501536&partnerID=8YFLogxK
U2 - 10.1093/ehjqcco/qcad010
DO - 10.1093/ehjqcco/qcad010
M3 - Article
C2 - 36808236
AN - SCOPUS:85182501536
SN - 2058-5225
VL - 10
SP - 89
EP - 98
JO - European Heart Journal - Quality of Care and Clinical Outcomes
JF - European Heart Journal - Quality of Care and Clinical Outcomes
IS - 1
ER -