Hilt Alexander D, Umans Victor A W M, Vossenberg Tessel N E, Schalij Martin J, Beeres Saskia L M A
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Cardiology, Noordwest Ziekenhuisgroep, location Alkmaar, Alkmaar, The Netherlands.
Neth Heart J. 2024 Mar;32(3):118-124. doi: 10.1007/s12471-023-01813-z. Epub 2023 Oct 12.
To date, claims data have not been used to study outcome differences between low and high socioeconomic status (SES) patients surviving ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in the Netherlands.
To evaluate STEMI and NSTEMI care among patients with low and high SES in the referral area of three Dutch percutaneous coronary intervention (PCI) centres, using claims data as a source.
STEMI and NSTEMI patients treated in 2015-2017 were included. Patients' SES scores were collected based on their postal code via an open access government database. In patients with low (SES1) and high (SES4) status, revascularisation strategies and secondary prevention medication were compared.
A total of 2065 SES1 patients (age 68 ± 13 years, 58% NSTEMI) and 1639 SES4 patients (age 68 ± 13 years, 63% NSTEMI) were included. PCI use was lower in SES1 compared to SES4 in both STEMI (80% vs 84%, p < 0.012) and NSTEMI (42% vs 48%, p < 0.002) patients. Coronary artery bypass grafting was performed more often in SES1 than in SES4 in both STEMI (7% vs 4%, p = NS) and NSTEMI (11% vs 7%, p < 0.001) patients. Optimal medical therapy use in STEMI patients was higher in SES1 compared to SES4 (52% vs 46%, p = 0.01) but comparable among NSTEMI patients (39% vs 40%, p = NS). One-year mortality was comparable in SES1 and SES4 patients following STEMI (14% vs 16%, p = NS) and NSTEMI (10% vs 11%, p = NS).
Combined analysis of claims data and area-specific socioeconomic statistics can provide unique insight into how to improve myocardial infarction care for low and high SES patients.
迄今为止，在荷兰，索赔数据尚未用于研究ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）存活患者中社会经济地位（SES）低和高的患者之间的结局差异。
以索赔数据为来源，评估荷兰三个经皮冠状动脉介入治疗（PCI）中心转诊区域内SES低和高的患者的STEMI和NSTEMI治疗情况。
纳入2015年至2017年接受治疗的STEMI和NSTEMI患者。通过开放获取的政府数据库，根据患者邮政编码收集其SES分数。比较低（SES1）和高（SES4）状态患者的血运重建策略和二级预防用药情况。
共纳入2065例SES1患者（年龄68±13岁，58%为NSTEMI）和1639例SES4患者（年龄68±13岁，63%为NSTEMI）。在STEMI（80%对84%，p<0.012）和NSTEMI（42%对48%，p<0.002）患者中，SES1患者的PCI使用率均低于SES4患者。在STEMI（7%对4%，p=无统计学意义）和NSTEMI（11%对7%，p<0.001）患者中，SES1患者进行冠状动脉旁路移植术的频率均高于SES4患者。STEMI患者中，SES1患者的最佳药物治疗使用率高于SES4患者（52%对46%，p=0.01），但在NSTEMI患者中两者相当（39%对40%，p=无统计学意义）。STEMI和NSTEMI后，SES1和SES4患者的1年死亡率相当（14%对16%，p=无统计学意义；10%对11%，p=无统计学意义）。
索赔数据与特定区域社会经济统计数据的综合分析可为改善SES低和高的患者的心肌梗死治疗提供独特见解。
