Subject: Country income
Subject: Mortality
Subject: NSTEMI
Subject: Quality indicators
Subject: Registry
Year: 2023
Type: Article
Title: Presentation, care and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology
Author: Nadarajah, Ramesh
Author: Ludman, Peter
Author: Laroche, Cécile
Author: Appelman, Yolande
Author: Brugaletta, Salvatore
Author: Budaj, Andrzej
Author: Bueno, Hector
Author: Huber, Kurt
Author: Kunadian, Vijay
Author: Leonardi, Sergio
Author: Lettino, Maddalena
Author: Milasinovic, Dejan
Author: Gale, Chris P and NSTEMI investigator group
Author: Vavlukis, Marija
Author: Poposka, Lidija
Author: Kalpak, Oliver
Author: Zafirovska Taleska, Biljana
Author: Pejkov, Hristo
Author: Mitevska Peovska, Irena
Author: Bojovski, Ivica
Author: Grueva, Elena
Abstract: Background: The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care and outcomes of NSTEMI by country income classification. Methods: Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack and death, and 30-day mortality. Results: Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared to patients in HICs, were younger, more commonly diabetic and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; p < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; p = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; p < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; p < 0.001) exhibited an inverse economic gradient. Conclusions: Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries.
Publisher: Oxford Academic
Relation: EORP NSTEMI Registry
Identifier: oai:repository.ukim.mk:20.500.12188/26378
Identifier: Nadarajah R, Ludman P, Laroche C, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP; NSTEMI investigator group. Presentation, care and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology. Eur Heart J Qual Care Clin Outcomes. 2023 Feb 3:qcad008. doi: 10.1093/ehjqcco/qcad008. Epub ahead of print. PMID: 36737420. Copy Download .nbib Format:
Identifier: http://hdl.handle.net/20.500.12188/26378Identifier: 10.1093/ehjqcco/qcad008
