2026-04-18T13:59:47Zhttps://repisalud.isciii.es/rest/oai/requestoai:repisalud.isciii.es:20.500.12105/164612024-09-27T08:02:46Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605
Repisalud
author
Nadarajah, Ramesh
author
Ludman, Peter
author
Laroche, Cécile
author
Appelman, Yolande
author
Brugaletta, Salvatore
author
Budaj, Andrzej
author
Bueno, Hector
author
Huber, Kurt
author
Kunadian, Vijay
author
Leonardi, Sergio
author
Lettino, Maddalena
author
Milasinovic, Dejan
author
Gale, Chris P
2023-09-15T08:25:21Z
2023-09-15T08:25:21Z
2023-09-12
Eur Heart J Qual Care Clin Outcomes. 2023 Sep 12;9(6):552-563.
http://hdl.handle.net/20.500.12105/16461
36737420
10.1093/ehjqcco/qcad008
2058-1742
European heart journal. Quality of care & clinical outcomes
BACKGROUND
The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care, and outcomes of NSTEMI by country income classification.
METHODS AND RESULTS
Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack, and death, and 30-day mortality. Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared with patients in HICs, were younger, more commonly diabetic, and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; P < 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; P = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; P < 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; P < 0.001) exhibited an inverse economic gradient.
CONCLUSION
Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries.
eng
Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology.
journal article
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Presentation_care_and_outcomes_Eur Heart J Qual Care Clin Outcomes_2023.pdf
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Presentation_care_and_outcomes_Eur Heart J Qual Care Clin Outcomes_2023.pdf.txt