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Impact of income status on prognosis of acute coronary syndrome patients during Greek financial crisis

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Abstract

Background

The effect of income status on patient outcome merits investigation during periods of financial crisis. We evaluated the impact of income status on out-of-hospital prognosis in a cohort of acute coronary syndrome (ACS) patients, included in a countrywide study during a period of financial crisis.

Methods

The study is a secondary analysis of a prospective, multicenter, observational study–the PHAETHON study—enrolling consecutive ACS patients in 37 hospitals in Greece. Patients were classified as low or high income based on the reported net annual household income using as a cut-off point the relative poverty threshold for Greece of 12,000 Euros. The outcome measure was survival free of the primary composite endpoint (cardiovascular death, myocardial infarction, stroke/transient ischemic attack, urgent revascularization and urgent hospitalization due to cardiovascular causes).

Results

The study population included 794 patients. The administration rate of evidence-based medications was similar in the low- (n = 455) and high-income (n = 339) groups during hospitalization and upon discharge. In a median follow-up of 189 days (interquartile range: 180–212 days), low-income patients had 92 % higher risk of the combined endpoint as compared to high-income patients [Hazard ratio (HR):1.92, 95 % CI:1.25–2.94, p = 0.003]. The effect of low-income status on the combined outcome remained significant after adjustment for age, gender and depression (HR:1.59, 95 % CI:1.02–2.49; p = 0.043).

Conclusions

In a period of financial crisis, low income is a significant and independent predictor of poor out-of-hospital outcome in ACS patients. This association has profound implications and should be taken into consideration by public health policy makers.

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Funding

The study was supported by a grant from Astrazeneca. The funding source had no involvement in the study design, the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the article for publication. This work was undertaken and supported by the Hellenic Cardiovascular Research Society.

Author information

Authors and Affiliations

  1. Henry Dunant Hospital Center Athens, 18 Parmenionos Street, 13676, Thrakomakedones, Greece

    George Andrikopoulos & Stylianos Tzeis

  2. Hippokration Hospital, University of Athens Medical School, Athens, Greece

    Dimitrios Terentes-Printzios & Charalampos Vlachopoulos

  3. Attikon University Hospital, Athens, Greece

    Christos Varounis

  4. General Hospital of Halkida, Chalkida, Greece

    Ioannis Mantas

  5. Konstantopoulio General Hospital, Athens, Greece

    Sotirios Patsilinakos

  6. Bodosakeio General Hospital of Ptolemaida, Ptolemaida, Greece

    Stylianos Lampropoulos

  7. Thriassio General Hospital, Athens, Greece

    Christoforos Olympios

  8. Skylitsion General Hospital of Chios, Chios, Greece

    Athanasios Kartalis

  9. Asklipio General Hospital of Voula, Voula, Greece

    Athanasios Manolis

  10. General Hospital of Komotini, Komotini, Greece

    Alexandros Gotsis

  11. University Hospital of Larissa, Larissa, Greece

    Filippos Triposkiadis

  12. Achilopouleio General Hospital of Volos, Volos, Greece

    Themistoklis Tsaknakis

  13. University Hospital of Ioannina, Ioannina, Greece

    Ioannis Goudevenos

  14. Papageorgiou General Hospital, Pavlos melas, Greece

    Ioannis Kaprinis

  15. General Hospital of Chania, Mournies, Greece

    Athanasios Pras

  16. General Hospital Larissa, Larissa, Greece

    Fotios Vasiliou

  17. General Hospital of Thiva, Thiva, Greece

    Emmanouil Skoumpourdis

  18. General Hospital of Preveza, Preveza, Greece

    Gerasimoula Sakka

  19. General Hospital of Corfu, Corfu, Greece

    Antonios Draganigos

  20. University Hospital of Heraklion, Heraklion, Greece

    Panos Vardas

Authors
  1. George Andrikopoulos
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  2. Stylianos Tzeis
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  3. Dimitrios Terentes-Printzios
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  4. Christos Varounis
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  5. Charalampos Vlachopoulos
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  6. Ioannis Mantas
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  7. Sotirios Patsilinakos
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  8. Stylianos Lampropoulos
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  9. Christoforos Olympios
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  10. Athanasios Kartalis
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  11. Athanasios Manolis
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  12. Alexandros Gotsis
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  13. Filippos Triposkiadis
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  14. Themistoklis Tsaknakis
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  15. Ioannis Goudevenos
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  16. Ioannis Kaprinis
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  17. Athanasios Pras
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  18. Fotios Vasiliou
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  19. Emmanouil Skoumpourdis
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  20. Gerasimoula Sakka
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  21. Antonios Draganigos
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  22. Panos Vardas
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Corresponding author

Correspondence to George Andrikopoulos.

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Appendix

Appendix

Principal investigators: Professor Panos Vardas, Dr. George Andrikopoulos.

Study coordinators: Stylianos Tzeis, Dimitrios Terentes-Printzios.

Participating centers and investigators

  1. 1.

    Patras University Hospital, Patras: A. Siapika, K. Stavrou, P. Theodorou, D. Alexopoulos.

  2. 2.

    Henry Dunant Hospital Center, Athens: I. Nastas, S. Pastromas, S. Tzeis, G. Andrikopoulos.

  3. 3.

    General Hospital of Mytilini, Mytilini: G. Varlamos, P. Andronikos.

  4. 4.

    University Hospital of Heraklion: I. Saloustros, P. Vardas.

  5. 5.

    General Hospital Larissa: K. Ntoulas, F. Vasiliou.

  6. 6.

    AHEPA University Hospital, Thessaloniki: A. Megarisiotou, K. Dimitriou, V. Vasilikos.

  7. 7.

    Komotini General Hospital: E. Gidaris, A. Gotsis.

  8. 8.

    University Hospital of Ioannina: G. Liappas, I. Goudevenos.

  9. 9.

    Venizeleio General Hospital, Heraklion: A. Dermitzakis.

  10. 10.

    General Hospital of Corfu: N. Kalantzis, A. Draganigos.

  11. 11.

    General Hospital of Kalamata: I. Pisimisis, S. Zompolos.

  12. 12.

    Attikon University Hospital, Athens: F. Kolokathis, I. Koniari, E. Iliodromitis.

  13. 13.

    Papageorgiou General Hospital, Thessaloniki: D. Efthimiou V. Sahpekidis.

  14. 14.

    Skylitsion General Hospital, Chios: E. Papatheodorou, A. Kartalis, G. Georgiopoulos, N. Smirnioudis.

  15. 15.

    General Hospital Agia Varvara, Attica: D. Kontogianni, A. Kranidis.

  16. 16.

    2nd IKA Hospital, Thessaloniki: C. Kyrpizidis.

  17. 17.

    Bodosakeio General Hospital of Ptolemaida: S. Lampropoulos.

  18. 18.

    Sotiria Thoracic Diseases Hospital, Athens: N. Marinakis, S. Limperi.

  19. 19.

    General Hospital of Halkida: V. Falireas, K. Toli, I. Mantas.

  20. 20.

    Asklipio General Hospital of Voula: N. Xiotelis, A. Giannakopoulos, A. Daskalaki, A. Manolis.

  21. 21.

    General Hospital of Sparti: M. Driva, S. Mavridis.

  22. 22.

    General Hospital of Edessa: J. Karadoumanis, K. Oikonomou.

  23. 23.

    Thriasio General Hospital, Elefsina: G. Psarou, C. Olympios.

  24. 24.

    Konstantopoulio General Hospital, Athens: A. Anadiotis, S. Patsilinakos.

  25. 25.

    Chania General Hospital: C. Kaukala, A. Pras.

  26. 26.

    Euroclinic Hospital of Athens: G. Goumas, D. Richter.

  27. 27.

    General Hospital of Preveza: D. Padazis, G. Sakka.

  28. 28.

    General Hospital of Thiva: M. Scoubourdis.

  29. 29.

    University Hospital of Alexandroupolis: D. Stakos.

  30. 30.

    Hippokration University Hospital Athens: D. Terentes-Printzios, C. Vlachopoulos, X. Stefanadis.

  31. 31.

    General Hospital of Aigio: A. Ampousamala, I. Siclimiris, I. Stiliadis.

  32. 32.

    General Hospital of Kavala: A. Chatzipapatheodoridis, N. Kampouridis, D. Simeonidis.

  33. 33.

    University Hospital of Larissa: M. Dalapasxa, F. Triposkiadis.

  34. 34.

    Volos General Hospital: K. Anastasiou, T. Tsaknakis.

  35. 35.

    Tzaneio General Hospital of Piraeus: A. Destounis, S. Foussas.

  36. 36.

    Hippokration General Hospital, Thessaloniki: K. Rossios, N. Fragakis.

  37. 37.

    General Hospital of Tripoli: A. Giannoulis, D. Chrissos.

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Andrikopoulos, G., Tzeis, S., Terentes-Printzios, D. et al. Impact of income status on prognosis of acute coronary syndrome patients during Greek financial crisis. Clin Res Cardiol 105, 518–526 (2016). https://doi.org/10.1007/s00392-015-0948-7

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  • DOI: https://doi.org/10.1007/s00392-015-0948-7

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