低和高社会经济环境中的心肌梗塞护理:索赔数据分析
Alexander D Hilt1, Victor A W M Umans2, Tessel N E Vossenberg3
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
概括
这项研究表明,社会经济地位影响心肌梗塞治疗,较低SES患者接受皮肤冠状动脉干预 (PCI) 较少,但在ST升高心肌梗塞 (STEMI) 和非ST升高心肌梗塞 (NSTEMI) 后的一年死亡率相似.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 索赔数据以前没有用于比较在荷兰心肌梗塞 (STEMI和NSTEMI) 后低社会经济地位 (SES) 和高社会经济地位 (SES) 患者的结果.
- 了解心血管保健中的社会经济差异对于改善患者的治疗结果至关重要.
研究的目的:
- 评估低社会经济地位 (SES) 和高社会经济地位 (SES) 患者之间ST升高心肌梗塞 (STEMI) 和非ST升高心肌梗塞 (NSTEMI) 的护理差异.
- 利用荷兰索赔数据分析这些患者群体的治疗策略和二次预防药物使用情况.
主要方法:
- 在2015-2017年期间接受治疗的STEMI和NSTEMI患者的回顾性分析.
- 社会经济地位 (SES) 通过公开政府数据库中的邮政编码数据来确定,将患者分为低 (SES1) 和高 (SES4) 组.
- 在SES1和SES4患者中,重新血管化的策略和二次预防药物的使用进行了比较.
主要成果:
- 与高SES (SES4) 患者相比,PCI的使用在低SES (SES1) 患者中较低,无论是STEMI (80% vs 84%) 还是NSTEMI (42% vs 48%).
- 在SES1患者中,冠状动脉旁路移植在STEMI (7%对4%) 和NSTEMI (11%对7%) 两种病例中更频繁.
- 在SES1 STEMI患者中,最佳的药物治疗使用率较高 (52%对46%),但在SES群体中,在STEMI和NSTEMI中,一年死亡率是可比的.
结论:
- 索赔数据与区域特定的社会经济信息相结合,为心肌梗塞护理差异提供了有价值的见解.
- 需要采取干预措施来解决皮肤穿透冠状动脉干预 (PCI) 和基于社会经济地位 (SES) 的治疗策略的变化.
- 尽管有治疗差异,但STEMI和NSTEMI后的一年死亡率在低SES患者和高SES患者之间是相似的.
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