Background

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.

Aim

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.

Methods

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.

Results

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).

Conclusion

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.

中文翻译：

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低社会经济环境和高社会经济环境下的心肌梗死护理：索赔数据分析

背景

迄今为止，索赔数据尚未用于研究荷兰 ST 段抬高型心肌梗死 (STEMI) 和非 ST 段抬高型心肌梗死 (NSTEMI) 幸存的低社会经济地位 (SES) 患者和高社会经济地位 (SES) 患者之间的结果差异。

目的

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) 中心转诊区内低 SES 和高 SES 患者的 STEMI 和 NSTEMI 护理。

方法

包括 2015-2017 年接受治疗的 STEMI 和 NSTEMI 患者。患者的 SES 分数是通过开放获取的政府数据库根据其邮政编码收集的。在低（SES1）和高（SES4）状态的患者中，比较了血运重建策略和二级预防药物。

结果

总共纳入了 2065 名 SES1 患者（年龄 68 ± 13 岁，58% NSTEMI）和 1639 名 SES4 患者（年龄 68 ± 13 岁，63% NSTEMI）。STEMI（80% vs 84%， p  < 0.012）和 NSTEMI（42% vs 48%，p  < 0.002）患者中 SES1 的 PCI 使用率低于 SES4 。在 STEMI（7% vs 4%， p  = NS）和 NSTEMI（11% vs 7%，p  < 0.001）患者中，SES1 患者比 SES4 患者更常进行冠状动脉旁路移植术。与 SES4 相比，SES1 中 STEMI 患者的最佳药物治疗使用率更高（52% vs 46%，p  = 0.01），但 NSTEMI 患者中的最佳药物治疗使用率相当（39% vs 40%，p  = NS）。STEMI（14% vs 16%， p  = NS）和 NSTEMI（10% vs 11%，p  = NS）后 SES1 和 SES4 患者的一年死亡率相当。

结论

对索赔数据和特定地区社会经济统计数据的综合分析可以为如何改善低和高 SES 患者的心肌梗死护理提供独特的见解。