Social and economical aspects in the use of resources in patients with acute coronary syndromes

pp 251-260

Abstract

High complexity resources in acute coro­nary syndromes mean high expenses. Social and economical aspects may be factors con­ditioning the medical decision-making pro­cess. 

Goal 

To assess whether social and economical features in a population with acute coronary syndromes influence the implementation of resources or the evolution of patients. 

Method 

A registry of 828 patients with acute coro­nary syndromes (unstable angina and acute myocardial infarction) was carried out in a prospective and consecutive way, in 18 centers with high complexity resources availability. Social and economical aspects were registered, as well as types of medical insurance, clinical features at admission and evolution and complementary studies done. 

Results 

Average age was 65.76±12 years, 69% of pa­tients were male, 26% had had a previous myo­cardial infarction. Half of the population earned less than $900 monthly. In this group is observed: older age (68 vs. 63 years p>0.001), more number of previous of angina events (35% vs. 27% p=0.01) and high risk unstable angina at admission (43% vs. 36% p=0.07). Similar CCG were performed in this group (43% vs. 49% p=0.09), but less coronary angioplasties (18% vs. 24% p< 0.02) and use of stents (10% vs 16% p<0.01). The group showed a greater mortal­ity during evolution (7% vs. 3% p<0.01). The multiple variable analysis showed that age, previous infarction and low economic income were independent predictors of mortality. 

Conclusions 

Social and economical factors may influence medical decision-making process.