Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia.
Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
Eur Heart J Qual Care Clin Outcomes. 2024 Jan 12;10(1):89-98. doi: 10.1093/ehjqcco/qcad010.
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).
This population-based cohort study included consecutive patients transported by EMS with CS between 1 January 2015 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.
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.
较低的社会经济地位（SES）与心血管不良结局之间的关系已得到充分描述；然而，关于这一关系在心源性休克（CS）中探索的数据却很少。本研究旨在调查 SES 与接受紧急医疗服务（EMS）治疗的 CS 患者的发病率、护理质量或结局之间是否存在差异。
这是一项基于人群的队列研究，纳入了 2015 年 1 月 1 日至 2019 年 6 月 30 日期间在澳大利亚维多利亚州由 EMS 转运的 CS 连续患者。数据来自单独链接的救护车、医院和死亡率数据集。使用澳大利亚统计局（Australian Bureau of Statistics）编制的国家人口普查数据，将患者分为 SES 五分位数。共 2628 名患者由 EMS 治疗 CS。所有患者的 CS 标准化发病率为 11.8 [95%置信区间（95%CI），11.4-12.3] / 100000 人年，从 SES 最高到最低五分位数呈逐步增加（最低五分位数为 17.0/100000 人年，最高五分位数为 9.7/100000 人年，P 趋势<0.001）。SES 较低五分位数的患者更不可能就诊于大都市医院，而更有可能前往没有血运重建能力的内陆地区和偏远地区中心。SES 较低的患者中，由于非 ST 段抬高型心肌梗死（NSTEMI）或不稳定型心绞痛（UAP）导致 CS 的比例较高，总体上进行冠状动脉造影的可能性较小。多变量分析显示，与最高五分位数相比，SES 最低的三个五分位数患者在 30 天全因死亡率增加。
本基于人群的研究表明，SES 状况与 EMS 治疗的 CS 患者的发病率、护理指标和死亡率之间存在差异。这些发现概述了在这一人群中公平提供医疗服务所面临的挑战。
