EFFECT OF SOCIOECONOMIC STATUS ON THE ACCESSIBILITY AND OUTCOMES OF PRIMARY PCI IN ACUTE CORONARY SYNDROME PATIENTS IN PAKISTAN
Main Article Content
Keywords
Acute coronary syndrome, primary PCI, socioeconomic status, healthcare disparities, Pakistan, cardiovascular outcomes.
Abstract
Background: Acute coronary syndrome (ACS) encompasses conditions such as ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina, requiring immediate intervention to restore blood flow to the heart. Primary percutaneous coronary intervention (PCI) is the preferred treatment for STEMI, significantly reducing morbidity and mortality. Socioeconomic status (SES) can influence access to timely PCI and impact healthcare outcomes.
Objective: This study aimed to evaluate the effect of socioeconomic status on the accessibility and outcomes of primary PCI in ACS patients in Pakistan.
Methods: A quasi-experimental design was used to assess the impact of SES on primary PCI outcomes at Lady Reading Hospital, Peshawar, over six months (January to June 2023). Participants included 300 patients diagnosed with STEMI who required primary PCI. Based on income levels, patients were categorized into low, middle, and high SES groups. Data on baseline characteristics, time to PCI, hospital stay, and Post-PCI complications were collected using standardized forms. Statistical analysis was performed using SPSS version 25.0, with comparisons made using ANOVA, Kruskal-Wallis tests, and chi-square tests.
Results: The mean age of participants was 58.3 years (SD ± 11.2), with 60% males and 40% females. The mean time to PCI was significantly longer for the low SES group (120 minutes, SD ± 20) compared to the middle (100 minutes, SD ± 15) and high SES groups (80 minutes, SD ± 10) (p < 0.001). The mean hospital stay was longer for the low SES group (7.5 days, SD ± 2.0) compared to the middle (6.0 days, SD ± 1.5) and high SES groups (5.0 days, SD ± 1.0). Post-PCI complications were higher in the low SES group (20%) compared to the middle (15%) and high SES groups (10%).
Conclusion: Socioeconomic status significantly affects the accessibility and outcomes of primary PCI in ACS patients in Pakistan. Patients from lower SES backgrounds experience longer delays to PCI, extended hospital stays, and higher complication rates. Targeted interventions are needed to address these disparities and ensure equitable access to life-saving treatments for all ACS patients.
Objective: This study aimed to evaluate the effect of socioeconomic status on the accessibility and outcomes of primary PCI in ACS patients in Pakistan.
Methods: A quasi-experimental design was used to assess the impact of SES on primary PCI outcomes at Lady Reading Hospital, Peshawar, over six months (January to June 2023). Participants included 300 patients diagnosed with STEMI who required primary PCI. Based on income levels, patients were categorized into low, middle, and high SES groups. Data on baseline characteristics, time to PCI, hospital stay, and Post-PCI complications were collected using standardized forms. Statistical analysis was performed using SPSS version 25.0, with comparisons made using ANOVA, Kruskal-Wallis tests, and chi-square tests.
Results: The mean age of participants was 58.3 years (SD ± 11.2), with 60% males and 40% females. The mean time to PCI was significantly longer for the low SES group (120 minutes, SD ± 20) compared to the middle (100 minutes, SD ± 15) and high SES groups (80 minutes, SD ± 10) (p < 0.001). The mean hospital stay was longer for the low SES group (7.5 days, SD ± 2.0) compared to the middle (6.0 days, SD ± 1.5) and high SES groups (5.0 days, SD ± 1.0). Post-PCI complications were higher in the low SES group (20%) compared to the middle (15%) and high SES groups (10%).
Conclusion: Socioeconomic status significantly affects the accessibility and outcomes of primary PCI in ACS patients in Pakistan. Patients from lower SES backgrounds experience longer delays to PCI, extended hospital stays, and higher complication rates. Targeted interventions are needed to address these disparities and ensure equitable access to life-saving treatments for all ACS patients.
References
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10. Alter DA, Naylor CD, Austin PC, et al. Long-term MI outcomes in patients with high-risk cardiovascular disease. JAMA. 2004;291(22):2721-2730.
11. Srinivas VS, Hailpern SM, Koss E, et al. Effect of socioeconomic status on outcomes of patients undergoing percutaneous coronary intervention in the era of drug-eluting stents. J Am Coll Cardiol. 2009;53(15):1419-1427.
12. Glied S, Lleras-Muney A. Health inequality: Measurement and decomposition. J Health Econ. 2008;27(4):745-758.
13. Maddox TM, Reid KJ, Rumsfeld JS, et al. Coronary artery disease in young adults: clinical and angiographic characteristics and long-term outcomes. J Am Coll Cardiol. 2009;54(9):1068-1074.
14. Mohanan PP, Mathew R, Harikrishnan S, et al. Presentation, management, and outcomes of 25,748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34(2):121-129.
15. Khera S, Kolte D, Aronow WS, et al. Non-ST-elevation myocardial infarction in the United States: contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes. J Am Heart Assoc. 2014;3(4).
16. Bainey KR, Lai T, Armstrong PW, et al. Reperfusion strategies for ST elevation myocardial infarction: opportunities for improvement. Heart. 2014;100(19):1492-1498.
17. Canto JG, Zalenski RJ, Roe MT, et al. Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2. Circulation. 2002;106(24):3018-3023.
18. Mathews R, Peterson ED, Li S, et al. Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines. Circulation. 2011;124(2):154-163.
19. Yan AT, Yan RT, Tan M, et al. Management patterns in relation to risk stratification among patients with non-ST elevation acute coronary syndromes. Arch Intern Med. 2007;167(10):1009-1016.
2. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):529-555.
3. Goyal A, Yusuf S. The burden of cardiovascular disease in the Indian subcontinent. Indian J Med Res. 2006;124(3):235-244.
4. Ahmad K, Jafar TH, Siddiqui MS. Prevalence and determinants of coronary artery disease in a rural population of Pakistan. J Pak Med Assoc. 2005;55(9):364-368.
5. Gupta R, Gupta VP. Meta-analysis of coronary heart disease prevalence in India. Indian Heart J. 1996;48(3):241-245.
6. Mehta S, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009;360(21):2165-2175.
7. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: Part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746-2753.
8. Berger PB, Ellis SG, Holmes DR Jr, et al. Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction. Circulation. 1999;100(1):14-20.
9. Ko DT, Natarajan MK, Graham MM, et al. Temporal trends in the use of percutaneous coronary intervention and coronary artery bypass surgery in Canada. Am Heart J. 2011;162(2):254-259.
10. Alter DA, Naylor CD, Austin PC, et al. Long-term MI outcomes in patients with high-risk cardiovascular disease. JAMA. 2004;291(22):2721-2730.
11. Srinivas VS, Hailpern SM, Koss E, et al. Effect of socioeconomic status on outcomes of patients undergoing percutaneous coronary intervention in the era of drug-eluting stents. J Am Coll Cardiol. 2009;53(15):1419-1427.
12. Glied S, Lleras-Muney A. Health inequality: Measurement and decomposition. J Health Econ. 2008;27(4):745-758.
13. Maddox TM, Reid KJ, Rumsfeld JS, et al. Coronary artery disease in young adults: clinical and angiographic characteristics and long-term outcomes. J Am Coll Cardiol. 2009;54(9):1068-1074.
14. Mohanan PP, Mathew R, Harikrishnan S, et al. Presentation, management, and outcomes of 25,748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34(2):121-129.
15. Khera S, Kolte D, Aronow WS, et al. Non-ST-elevation myocardial infarction in the United States: contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes. J Am Heart Assoc. 2014;3(4).
16. Bainey KR, Lai T, Armstrong PW, et al. Reperfusion strategies for ST elevation myocardial infarction: opportunities for improvement. Heart. 2014;100(19):1492-1498.
17. Canto JG, Zalenski RJ, Roe MT, et al. Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2. Circulation. 2002;106(24):3018-3023.
18. Mathews R, Peterson ED, Li S, et al. Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines. Circulation. 2011;124(2):154-163.
19. Yan AT, Yan RT, Tan M, et al. Management patterns in relation to risk stratification among patients with non-ST elevation acute coronary syndromes. Arch Intern Med. 2007;167(10):1009-1016.
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Published
Jun 25, 2024
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How to Cite
Dr Rafi Ullah, Dr Honey Raj Vishno, Dr Syed Muzammil Shah, Dr Muhammad Abdur Rauf, Dr Fahad Raja Khan, & Dr Ejaz Ul Haq. (2024). EFFECT OF SOCIOECONOMIC STATUS ON THE ACCESSIBILITY AND OUTCOMES OF PRIMARY PCI IN ACUTE CORONARY SYNDROME PATIENTS IN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 2793-2799. https://doi.org/10.53555/jptcp.v31i6.7100
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Author Biographies
Dr Rafi Ullah
Cardiologist, Kuwait Teaching Hospital Peshawar, PakistanDr Honey Raj Vishno
Cardiology Resident, NICVD, Karachi, PakistanDr Syed Muzammil Shah
Medical Officer, Kuwait Teaching Hospital, PakistanDr Muhammad Abdur Rauf
Assistant Professor of Cardiology, Kuwait Teaching Hospital/Peshawar Medical College Peshawar, PakistanDr Fahad Raja Khan
Fellow Interventional Cardiology, Peshawar Institute of Cardiology, Pakistan,Dr Ejaz Ul Haq
Fellow Interventional Cardiology, NICVD Karachi, PakistanHow to Cite
Dr Rafi Ullah, Dr Honey Raj Vishno, Dr Syed Muzammil Shah, Dr Muhammad Abdur Rauf, Dr Fahad Raja Khan, & Dr Ejaz Ul Haq. (2024). EFFECT OF SOCIOECONOMIC STATUS ON THE ACCESSIBILITY AND OUTCOMES OF PRIMARY PCI IN ACUTE CORONARY SYNDROME PATIENTS IN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 2793-2799. https://doi.org/10.53555/jptcp.v31i6.7100