Factors Associated with Mortality following Acute Coronary Syndrome According to Patient Satisfaction

The factors associated with mortality following acute coronary syndrome (ACS) based on patient satisfaction are unknown. The objective was to describe and compare factors associated with 1-year mortality following ACS according to high versus low patient satisfaction with hospital stay, doctors, and nurses.

In a registry of 3565 patients presenting with ACS to 29 hospitals across 4 countries, we grouped patients by self-reported satisfaction with hospital stay reported at 1-month following ACS. The primary outcome was all-cause 1-year mortality following ACS, excluding patients with mortality before the initial 30-day follow-up. We examined associations of patient and hospitalization factors with risk of 1-year all-cause mortality in logistic regression models, unadjusted and adjusted for Global Registry of Acute Coronary Event (GRACE) risk score, reported as odds ratio (OR; 95% confidence interval).

In models adjusting for GRACE risk score, in the low satisfaction category, women, compared with men, had statistically similar odds of mortality (adjusted OR: 1.43 [0.99-2.04]). Lack of formal education (vs. any education) was associated with higher odds of mortality in the low satisfaction (aOR: 1.99 [1.33-3.04]; P < 0.01) and high satisfaction (aOR: 3.06 [1.93-5.00]; P < 0.001) categories (P _interaction = 0.30). Lack of employment (vs. employment) was associated with similar higher odds of mortality in the low satisfaction (aOR: 6.37 [2.83-18.25]; P < 0.001) and high satisfaction (aOR: 2.58 [1.40-5.21]; P < 0.01) categories (P _interaction = 0.08). Generally comparable results were obtained when analyzed by patient satisfaction with doctors and with nurses.

Education and employment were major factors associated with higher 1-year mortality following ACS, independent of patient satisfaction, and may inform tailored educational and outreach interventions to reduce mortality.