Clinical Research in Cardiology

, Volume 105, Issue 6, pp 518–526 | Cite as

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

  • George AndrikopoulosEmail author
  • Stylianos Tzeis
  • Dimitrios Terentes-Printzios
  • Christos Varounis
  • Charalampos Vlachopoulos
  • Ioannis Mantas
  • Sotirios Patsilinakos
  • Stylianos Lampropoulos
  • Christoforos Olympios
  • Athanasios Kartalis
  • Athanasios Manolis
  • Alexandros Gotsis
  • Filippos Triposkiadis
  • Themistoklis Tsaknakis
  • Ioannis Goudevenos
  • Ioannis Kaprinis
  • Athanasios Pras
  • Fotios Vasiliou
  • Emmanouil Skoumpourdis
  • Gerasimoula Sakka
  • Antonios Draganigos
  • Panos Vardas
Original Paper



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.


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).


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).


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.


Income Acute coronary syndrome Prognosis Financial crisis 



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.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • George Andrikopoulos
    • 1
    Email author
  • Stylianos Tzeis
    • 1
  • Dimitrios Terentes-Printzios
    • 2
  • Christos Varounis
    • 3
  • Charalampos Vlachopoulos
    • 2
  • Ioannis Mantas
    • 4
  • Sotirios Patsilinakos
    • 5
  • Stylianos Lampropoulos
    • 6
  • Christoforos Olympios
    • 7
  • Athanasios Kartalis
    • 8
  • Athanasios Manolis
    • 9
  • Alexandros Gotsis
    • 10
  • Filippos Triposkiadis
    • 11
  • Themistoklis Tsaknakis
    • 12
  • Ioannis Goudevenos
    • 13
  • Ioannis Kaprinis
    • 14
  • Athanasios Pras
    • 15
  • Fotios Vasiliou
    • 16
  • Emmanouil Skoumpourdis
    • 17
  • Gerasimoula Sakka
    • 18
  • Antonios Draganigos
    • 19
  • Panos Vardas
    • 20
  1. 1.Henry Dunant Hospital Center AthensThrakomakedonesGreece
  2. 2.Hippokration HospitalUniversity of Athens Medical SchoolAthensGreece
  3. 3.Attikon University HospitalAthensGreece
  4. 4.General Hospital of HalkidaChalkidaGreece
  5. 5.Konstantopoulio General HospitalAthensGreece
  6. 6.Bodosakeio General Hospital of PtolemaidaPtolemaidaGreece
  7. 7.Thriassio General HospitalAthensGreece
  8. 8.Skylitsion General Hospital of ChiosChiosGreece
  9. 9.Asklipio General Hospital of VoulaVoulaGreece
  10. 10.General Hospital of KomotiniKomotiniGreece
  11. 11.University Hospital of LarissaLarissaGreece
  12. 12.Achilopouleio General Hospital of VolosVolosGreece
  13. 13.University Hospital of IoanninaIoanninaGreece
  14. 14.Papageorgiou General HospitalPavlos melasGreece
  15. 15.General Hospital of ChaniaMourniesGreece
  16. 16.General Hospital LarissaLarissaGreece
  17. 17.General Hospital of ThivaThivaGreece
  18. 18.General Hospital of PrevezaPrevezaGreece
  19. 19.General Hospital of CorfuCorfuGreece
  20. 20.University Hospital of HeraklionHeraklionGreece

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