Access to percutaneous transluminal coronary angioplasty and 30-day mortality in patients with incident STEMI: Differentials by educational level and gender over 11 years

Cacciani, Laura; Agabiti, Nera; Bargagli, Anna Maria; Davoli, Marina

doi:10.1371/journal.pone.0175038

Cited by 6 publications

(4 citation statements)

References 37 publications

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“…Instead, we observed a considerable improvement among the least educated patients, which helped to fill the equity gap in terms of access to effective treatment attributable to educational level. Cacciani et al [ 27 ] had already reported a similar result after observing a decreasing educational differential in the access to PCI between 2001 and 2011, using data from a cohort of STEMI residents in Rome (Italy). This finding seems to suggest that the efforts of the health system in improving health care quality could also be effective in improving equity.…”

Section: Discussionmentioning

confidence: 63%

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Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)

Ventura¹,

Fusco²,

Bontempi³

et al. 2018

PLoS ONE

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BackgroundInequalities in health among groups of various socio-economic status (as measured by education, occupation, and income) constitute one of the main challenges for public health. Since 2006, the Lazio Regional Outcome Evaluation Program (P.Re.Val.E.), presents a set of indicators of hospital performance based on quality standards driven by strong clinical recommendations, and measures the variation in the access to effective health care for different population groups and providers in the Lazio Region. One of the aims of the program was to compare population subgroups in order to promote equity in service provision. Since June 2013, a new management strategy has been put in place that assigned specific goals based on performance assessment to the chief executive officers of the hospitals.AimTo evaluate whether, in recent years, there has been a reduction in the differential access to effective health care, among individuals with different educational levels.MethodsWe enrolled all patients discharged from both public and private hospitals of the Lazio region between 2012 and 2015, living in Lazio region. We analysed the proportion of patients with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention within 90 minutes (primary PCI), the proportion of patients with hip fracture (HF) who underwent surgery within 2 days, and the proportion of women with primary C-section. We applied multivariate logistic regression models to assess the effect of educational level on health outcomes, adjusting for demographic characteristics and comorbidities that could affect the outcomes. For each year of the study period, we compared adjusted proportions of outcomes for the highest and the lowest level of education by using percentage differences.ResultsIn the Lazio region, 44.6% of STEMI patients (N = 3,299) were treated with primary PCI, 54.4% of patients with hip fractures (N = 6,602) underwent surgery within 2 days, and 27.7% of women without a previous C-section (N = 34,718) delivered via C-section, in 2015. The corresponding proportions in 2012 were 27.8%, 31.3% and 31.5%, respectively. By comparing the adjusted proportions in patients with the highest education level (a university degree or higher) to those with the lowest level education level (None/Primary school), a decrease in the percentage difference was observed during the study period. In STEMI and delivery cohorts, the improvement of outcomes involved the least and the most educated patients, respectively, and the difference between the two educational levels was close to zero in 2015, whereas for hip patients, the improvement was more evident among the less educated patients.ConclusionsIn the Lazio region, we observed a reduction in the differential access to effective heath care by educational level, in different clinical areas. Different factors might explain these results. On top of the public disclosure of outcome data, the management strategy applied in mid-2013 might have driven the overall improvement of the healt...

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Section: Discussionmentioning

confidence: 63%

“…However, only a few studies have demonstrated whether an overall improvement in the quality of care has had a differential impact on different subgroups of the population [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)

Ventura¹,

Fusco²,

Bontempi³

et al. 2018

PLoS ONE

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“…Although clinical characteristics, vital signs and Killip class were fairly consistent across periods, patients in the postoutbreak time were about 5 years younger and had a 13-point lower percentage of female, comparing those in the outbreak time. Although the explication of reasons for these changes is beyond the scope of our study, a number of prior studies pointed out the fact that elderly and female patients with STEMI have higher in-hospital mortality or worse clinical outcomes than the young and the male 29 30. Nevertheless, data of our study provide additional information that neither the risk profile of patients hospitalised with STEMI has significantly changed in the postoutbreak time and nor have the clinical outcomes.…”

Section: Discussionmentioning

confidence: 76%

Quality of healthcare and admission rates for acute cardiac events during COVID-19 pandemic: a retrospective cohort study on ST-segment-elevation myocardial infarction in China

Zhou

et al. 2022

BMJ Open

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ObjectiveTo evaluate changes in admission rates for and quality of healthcare of ST-segment-elevation myocardial infarction (STEMI) during the period of the COVID-19 outbreak and postoutbreak.MethodsWe conducted a retrospective study among patients with STEMI in the outbreak time and the postoutbreak time.DesignTo examine the changes in the admission rates and in quality of healthcare, by comparison between periods of the postoutbreak and the outbreak, and between the postoutbreak and the corresponding periods.SettingData for this analysis were included from patients discharge diagnosed with STEMI from all the hospitals of Suzhou in each month of the year until the end of July 2020.Participants1965 STEMI admissions.Primary and secondary outcome measuresThe primary outcome was the number of moecondary outcomnthly STEMI admissions, and the secondary outcomes were the quality metrics of STEMI healthcare.ResultsThere were a 53% and 38% fall in daily admissions at the phase of outbreak and postoutbreak, compared with the 2019 corresponding. There remained a gap in actual number of postoutbreak admissions at 306 and the predicted number at 497, an estimated 26 deaths due to STEMI would have been caused by not seeking healthcare. Postoutbreak period of 2020 compared with corresponding period of 2019, the percentage of cases transferred by ambulance decreased from 9.3% to 4.2% (p=0.013), the door-to-balloon median time increased from 17.5 to 34.0 min (p=0.001) and the rate of percutaneous coronary intervention (PCI) therapy declined from 71.3% to 60.1% (p=0.002).ConclusionsThe impact of public health restrictions may lead to unexpected out-of-hospital deaths and compromised quality of healthcare for acute cardiac events. Delay or absence in patients should be continuously considered avoiding the secondary disaster of the pandemic. System delay should be modifiable for reversing the worst clinical outcomes from the COVID-19 outbreak, by coordination measures with focus on the balance between timely PCI procedure and minimising contamination of cardiac catheterisation rooms.

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“…Sex disparities in other cardiovascular diseases suggest that such finding may also derive from reasons not specific to VTE. Studies from Italy report higher post-ST-segment elevation myocardial infarction mortality and lower use of percutaneous coronary intervention in women than in men, 25,26 and, in line with international literature, 27 attribute the difference to older age at presentation as well as to treatment delay or suboptimal treatment among women. Both explanations may also apply to death from PE.…”

Section: Discussionmentioning

confidence: 78%

Decline in Overall Pulmonary Embolism-Related Mortality and Increasing Prevalence of Cancer-Associated Events in the Veneto Region (Italy), 2008–2019

et al. 2021

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Background. Despite evidence of ongoing epidemiological changes in deaths from venous thromboembolism in high-income countries, little recent information is available on the time trends in mortality related to PE as underlying or concomitant cause of death in Europe. Methods. We accessed the regional database of death certificates of Veneto Region (Northern Italy, population 4,900,000) from 2008 to 2019. We analysed the trends in crude and age-adjusted annual rates of mortality related to PE (reported either as underlying cause or in any position in the death certificate) using Joinpoint regression; in the contribution of PE to mortality (proportionate mortality); and, using logistic regression, in the association between PE and cancer at death. Results. Between 2008 and 2019, the age-standardized mortality rate related to PE in Veneto decreased from 20.7 to 12.6 annual deaths per 100,000 population for PE in any position of the death certificate, and from 4.6 to 2.2 annual deaths per 100,000 population for PE as underlying cause of death. PE-related proportionate mortality remained up to twice as high in women. The age- and sex-adjusted odds ratio for cancer in deaths with (vs. without) PE constantly increased from 1.01 (95% CI 0.88-1.16) in 2008 to 1.58 (95% CI 1.35-1.83) in 2019. Conclusions. The descending trend in PE-related mortality reported for Europe up to 2015 for both sexes continued thereafter in Northern Italy. However, sex differences in proportionate mortality persist, and the increasing association between PE and cancer at death may reflect changes in risk factor distribution or diagnostic practices.

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Access to percutaneous transluminal coronary angioplasty and 30-day mortality in patients with incident STEMI: Differentials by educational level and gender over 11 years

Cited by 6 publications

References 37 publications

Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)

Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)

Quality of healthcare and admission rates for acute cardiac events during COVID-19 pandemic: a retrospective cohort study on ST-segment-elevation myocardial infarction in China

Decline in Overall Pulmonary Embolism-Related Mortality and Increasing Prevalence of Cancer-Associated Events in the Veneto Region (Italy), 2008–2019

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