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Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry

BACKGROUND: Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary pre...

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Autores principales: Nielsen, Susanne J., Karlsson, Martin, Björklund, Erik, Martinsson, Andreas, Hansson, Emma C., Malm, Carl Johan, Pivodic, Aldina, Jeppsson, Anders
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335537/
https://www.ncbi.nlm.nih.gov/pubmed/32114890
http://dx.doi.org/10.1161/JAHA.119.015491
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author Nielsen, Susanne J.
Karlsson, Martin
Björklund, Erik
Martinsson, Andreas
Hansson, Emma C.
Malm, Carl Johan
Pivodic, Aldina
Jeppsson, Anders
author_facet Nielsen, Susanne J.
Karlsson, Martin
Björklund, Erik
Martinsson, Andreas
Hansson, Emma C.
Malm, Carl Johan
Pivodic, Aldina
Jeppsson, Anders
author_sort Nielsen, Susanne J.
collection PubMed
description BACKGROUND: Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long‐term survival in CABG patients with a low income and short education. METHODS AND RESULTS: Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population‐based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β‐blockers, and RAAS inhibitors), socioeconomic factors, patient characteristics, comorbidity, and long‐term mortaity were merged. All‐cause mortality risk was estimated using multivariable Cox regression models adjusted for patient characteristics, baseline comorbidities, time‐updated secondary prevention medications, and socioeconomic status. Long‐term mortality was higher in patients with a low income and short education. Statins and platelet inhibitors were dispensed less often to patients with a low income, both at baseline and after 8 years. The decline in dispensing over time was steeper for low‐income patients. Short education was not associated with reduced dispensing of any secondary prevention medication. Use of statins (adjusted hazard ratio=0.57 [95% CI, 0.53–0.61]), RAAS inhibitors (adjusted hazard ratio=0.78 [0.73–0.84]), and platelet inhibitors (adjusted hazard ratio=0.74 [0.68–0.80]) were associated with reduced long‐term mortality irrespective of socioeconomic status. CONCLUSIONS: Secondary prevention medications are dispensed less often after CABG to patients with low income. Underusage of secondary prevention medications after CABG is associated with increased mortality risk independently of income and extent of education.
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spelling pubmed-73355372020-07-08 Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry Nielsen, Susanne J. Karlsson, Martin Björklund, Erik Martinsson, Andreas Hansson, Emma C. Malm, Carl Johan Pivodic, Aldina Jeppsson, Anders J Am Heart Assoc Original Research BACKGROUND: Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long‐term survival in CABG patients with a low income and short education. METHODS AND RESULTS: Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population‐based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β‐blockers, and RAAS inhibitors), socioeconomic factors, patient characteristics, comorbidity, and long‐term mortaity were merged. All‐cause mortality risk was estimated using multivariable Cox regression models adjusted for patient characteristics, baseline comorbidities, time‐updated secondary prevention medications, and socioeconomic status. Long‐term mortality was higher in patients with a low income and short education. Statins and platelet inhibitors were dispensed less often to patients with a low income, both at baseline and after 8 years. The decline in dispensing over time was steeper for low‐income patients. Short education was not associated with reduced dispensing of any secondary prevention medication. Use of statins (adjusted hazard ratio=0.57 [95% CI, 0.53–0.61]), RAAS inhibitors (adjusted hazard ratio=0.78 [0.73–0.84]), and platelet inhibitors (adjusted hazard ratio=0.74 [0.68–0.80]) were associated with reduced long‐term mortality irrespective of socioeconomic status. CONCLUSIONS: Secondary prevention medications are dispensed less often after CABG to patients with low income. Underusage of secondary prevention medications after CABG is associated with increased mortality risk independently of income and extent of education. John Wiley and Sons Inc. 2020-03-02 /pmc/articles/PMC7335537/ /pubmed/32114890 http://dx.doi.org/10.1161/JAHA.119.015491 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Nielsen, Susanne J.
Karlsson, Martin
Björklund, Erik
Martinsson, Andreas
Hansson, Emma C.
Malm, Carl Johan
Pivodic, Aldina
Jeppsson, Anders
Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry
title Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry
title_full Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry
title_fullStr Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry
title_full_unstemmed Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry
title_short Socioeconomic Factors, Secondary Prevention Medication, and Long‐Term Survival After Coronary Artery Bypass Grafting: A Population‐Based Cohort Study From the SWEDEHEART Registry
title_sort socioeconomic factors, secondary prevention medication, and long‐term survival after coronary artery bypass grafting: a population‐based cohort study from the swedeheart registry
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335537/
https://www.ncbi.nlm.nih.gov/pubmed/32114890
http://dx.doi.org/10.1161/JAHA.119.015491
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