Socioeconomic differences in coronary procedures and survival after out-of-hospital cardiac arrest: A nationwide Danish study
Sidsel Møller, Mads Wissenberg, Kristian Kragholm, Fredrik Folke, Carolina Malta Hansen, Kristian Bundgaard Ringgren, Julie Andersen, Carlo Alberto Barcella, Freddy Lippert, Lars Køber, Gunnar Gislason, Thomas Alexander Gerds, Christian Torp‐Pedersen
Abstract
AIM: It remains unclear whether socioeconomic differences exist in post-resuscitation care in out-of-hospital cardiac arrests (OHCA). We aimed to examine socioeconomic differences in coronary procedures and survival after OHCA. METHODS: OHCA patients ≥30 years of cardiac cause with a hospital admission from the Danish Cardiac Arrest Registry, 2001-2014, were divided according to quartiles of household income (lowest, low, high, highest). Associations of income, coronary procedures and 30-day survival were examined by age-standardized incidence rates and incidence rate ratios (IRR), and by logistic regression. RESULTS: A total of 6105 patients were included. Higher-income patients were younger, males and had less comorbidity-burden. Higher-income patients had higher incidence rates for coronary angiographies both day 0-1 and day 2-7 after OHCA (day 0-1: highest: IRR 1.79, 95%CI 1.46-2.21; high: IRR 1.28, 95%CI 1.10-1.51; low: IRR 1.05, 95%CI 0.90-1.23), compared to lowest. Fifty-four percentage of the patients undergoing a coronary angiography received percutaneous-coronary-intervention or coronary-artery-bypass-grafting with no difference among three of the four groups, but lower IRR in low-income patients (IRR 0.74, 95%CI 0.61-0.89) compared to lowest. Higher-income patients had also higher odds for 30-day survival compared to lowest, both in patients with (highest: OR 1.61, 95%CI 1.12-2.32; high: OR 1.13, 95%CI 0.80-1.60; low: OR 1.14, 95%CI 0.81-1.61) and without (highest: OR 2.54, 95%CI 1.83-3.53; high: OR 1.41, 95%CI 1.06-1.87; low: OR 1.12, 95%CI 0.86-1.47) coronary angiography day 0-1. CONCLUSION: Higher-income patients were found associated with more performed coronary angiographies after OHCA, and higher odds for 30-day survival.