Rashid Shabnam, Simms Alexander, Batin Phillip, Kurian John, Gale Chris P
Shabnam Rashid, Alexander Simms, Department of Cardiology, Leeds General Infirmary, West Yorkshire LS1 3EX, United Kingdom.
World J Cardiol. 2015 Dec 26;7(12):895-901. doi: 10.4330/wjc.v7.i12.895.
Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction (AMI), yet despite these, significant inequalities exist in the care of these patients. The elderly, deprived socioeconomic groups, females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI, thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group, i.e., low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.
冠心病是发达国家的头号死因。针对急性心肌梗死（AMI）的管理已有相关指南，然而，尽管如此，在这些患者的护理方面仍存在显著的不平等。老年人、社会经济地位低下的群体、女性和非白种人是实践往往更频繁偏离证据基础的患者群体。与年轻患者相比，老年患者发生AMI后的死亡率往往更高。他们还往往表现出与AMI不完全一致的症状，从而部分导致了年轻患者和老年患者在护理方面的不平等。此外，针对老年AMI患者缺乏指南往往会使决策具有挑战性，这可能是年轻患者和老年患者护理差异普遍存在的原因。其他患者，如社会经济地位较低的群体，即低收入且受教育程度低于高中的患者，与社会经济地位较高的患者相比，发生AMI后健康状况往往较差，预期寿命也较短。社会经济地位较低也被认为是导致AMI患者护理中种族和地域差异的原因。与男性相比，患有AMI的女性接受的治疗不够积极，预后也较差。然而，即使女性接受相同的治疗，她们在医院的死亡率仍然较高，这表明性别很可能是导致预后差异的原因。本综述的目的是确定AMI患者护理中的不平等现象，并探讨这些现象发生的潜在原因。更加关注管理并更好地理解这些护理不平等的根本原因，可能有助于降低与AMI相关的发病率和死亡率。
