Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.
Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden.
J Am Heart Assoc. 2020 Mar 3;9(5):e015491. doi: 10.1161/JAHA.119.015491. Epub 2020 Mar 2.
Background Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long-term survival in CABG patients with a low income and short education. Methods and Results Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population-based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β-blockers, and RAAS inhibitors), socioeconomic factors, patient characteristics, comorbidity, and long-term mortaity were merged. All-cause mortality risk was estimated using multivariable Cox regression models adjusted for patient characteristics, baseline comorbidities, time-updated secondary prevention medications, and socioeconomic status. Long-term mortality was higher in patients with a low income and short education. Statins and platelet inhibitors were dispensed less often to patients with a low income, both at baseline and after 8 years. The decline in dispensing over time was steeper for low-income patients. Short education was not associated with reduced dispensing of any secondary prevention medication. Use of statins (adjusted hazard ratio=0.57 [95% CI, 0.53-0.61]), RAAS inhibitors (adjusted hazard ratio=0.78 [0.73-0.84]), and platelet inhibitors (adjusted hazard ratio=0.74 [0.68-0.80]) were associated with reduced long-term mortality irrespective of socioeconomic status. Conclusions Secondary prevention medications are dispensed less often after CABG to patients with low income. Underusage of secondary prevention medications after CABG is associated with increased mortality risk independently of income and extent of education.
收入低和受教育程度低与冠状动脉旁路移植术（CABG）后的生存预后不良独立相关，而使用二级预防药物与生存预后改善相关。我们研究了收入低和受教育程度低的 CABG 患者是否因二级预防药物使用率低而导致长期生存预后不良。
本研究纳入了一项基于人群的队列研究，共纳入了 2006 年至 2015 年期间在瑞典接受 CABG 且出院后至少存活 6 个月的患者（n=28448）。来自 5 个国家登记处的个体患者数据，包括 SWEDEHEART（瑞典心脏病强化和发展网络系统，根据推荐疗法进行评估）登记处，涵盖二级预防药物（他汀类药物、血小板抑制剂、β受体阻滞剂和 RAAS 抑制剂）的使用情况、社会经济因素、患者特征、合并症和长期死亡率，进行了合并。使用多变量 Cox 回归模型估计全因死亡率，该模型调整了患者特征、基线合并症、时间更新的二级预防药物和社会经济状况。收入低和受教育程度低的患者长期死亡率更高。在基线和 8 年后，收入较低的患者他汀类药物和血小板抑制剂的使用率均较低。随着时间的推移，低收入患者的用药下降速度更快。受教育程度低与任何二级预防药物的使用率降低无关。使用他汀类药物（调整后的危险比=0.57 [95%CI，0.53-0.61]）、RAAS 抑制剂（调整后的危险比=0.78 [0.73-0.84]）和血小板抑制剂（调整后的危险比=0.74 [0.68-0.80]）与死亡率降低独立相关，与社会经济地位无关。
收入较低的 CABG 患者二级预防药物的使用率较低。CABG 后二级预防药物使用率低与死亡率风险增加独立相关，与收入和受教育程度无关。
