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http://hdl.handle.net/20.500.12188/26378
Title: | Presentation, care and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology | Authors: | Nadarajah, Ramesh Ludman, Peter Laroche, Cécile Appelman, Yolande Brugaletta, Salvatore Budaj, Andrzej Bueno, Hector Huber, Kurt Kunadian, Vijay Leonardi, Sergio Lettino, Maddalena Milasinovic, Dejan Gale, Chris P and NSTEMI investigator group Vavlukis, Marija Poposka, Lidija Kalpak, Oliver Zafirovska Taleska, Biljana Pejkov, Hristo Mitevska Peovska, Irena Bojovski, Ivica Grueva, Elena |
Keywords: | Country income Mortality NSTEMI Quality indicators Registry |
Issue Date: | 3-Feb-2023 | Publisher: | Oxford Academic | Source: | Nadarajah R, Ludman P, Laroche C, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP; NSTEMI investigator group. Presentation, care and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology. Eur Heart J Qual Care Clin Outcomes. 2023 Feb 3:qcad008. doi: 10.1093/ehjqcco/qcad008. Epub ahead of print. PMID: 36737420. Copy Download .nbib Format: | Project: | EORP NSTEMI Registry | Journal: | European heart journal. Quality of care & clinical outcomes | Abstract: | Background: The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care and outcomes of NSTEMI by country income classification. Methods: Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack and death, and 30-day mortality. Results: Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared to patients in HICs, were younger, more commonly diabetic and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; p < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; p = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; p < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; p < 0.001) exhibited an inverse economic gradient. Conclusions: Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries. | URI: | http://hdl.handle.net/20.500.12188/26378 | DOI: | 10.1093/ehjqcco/qcad008 |
Appears in Collections: | Faculty of Medicine: Journal Articles |
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qcad008.pdf | main document | 1.16 MB | Adobe PDF | View/Open |
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