Maëlle Achard, Cédric Follonier, Evelyne Fournier, David Carballo, Mattia Branca, Dik Heg, David Nanchen, Lorenz Räber, Roland Klingenberg, Stephan Windecker, Thomas F Lüscher, Christian M Matter, Nicolas Rodondi, François Mach, Baris Gencer
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The use of medical therapies, achievement of preventive targets and risk of clinical events were evaluated across ELs at baseline (N = 6040), 1-year (N = 5756) and 5-years (N = 2253) and presented with adjusted marginal odds ratios (mOR), average marginal effect (AME) and hazard ratios (HRs).</p><p><strong>Results: </strong>Among 6040 patients, the mean age was 63 years, and 81% were male. Participants with lower EL had a greater burden of cardiovascular risk factors at baseline. Compared with EL4 participants EL1 participants had lower adherence to cardiac rehabilitation (mOR = .6 [95% CI .5-.8], AME = -10%) and were less likely to be followed by a cardiologist (mOR .6 [95% CI .5-.8], AME = -6%). Use of medical therapies did neither differ across EL at discharge nor during follow-up. At 1 year, smoking cessation (mOR = .7 [95% CI .5-.9], AME = -10%) and weight reduction ≥5% among overweight or obese participants (mOR = .7 [95% CI .5-.9], AME = -6%) were less frequent in individuals with EL1 compared with EL4. At long term, achievement of LDL-C <1.8 mmol/L (<70 mg/dL) (mOR = .6 [95% CI .4-.9], AME = -9%) was less frequent in individuals with EL1 compared with EL4. Lower EL was associated with an increased risk of major acute coronary event (MACE) at short- (aHR = 1.4 [95% CI 1.0-2.0] for EL1 vs. EL4) and long term (aHR = 1.3 [95% CI 1.0-1.6] for EL1 vs. EL4) and all-cause death at long term (aHR = 1.6 [95% CI 1.1-2.2] for EL1 vs. EL4).</p><p><strong>Conclusion: </strong>In Switzerland, disparities in ACS care and outcomes remain across EL, emphasising the need for tailored interventions to reduce inequities.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70097"},"PeriodicalIF":3.6000,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Educational level, clinical outcomes and quality of care in a Swiss cohort of patients with acute coronary syndromes.\",\"authors\":\"Maëlle Achard, Cédric Follonier, Evelyne Fournier, David Carballo, Mattia Branca, Dik Heg, David Nanchen, Lorenz Räber, Roland Klingenberg, Stephan Windecker, Thomas F Lüscher, Christian M Matter, Nicolas Rodondi, François Mach, Baris Gencer\",\"doi\":\"10.1111/eci.70097\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite universal coverage, inequities persist in acute coronary syndrome (ACS) care. This study examines how educational levels impact the quality and outcomes of health care.</p><p><strong>Methods: </strong>A cohort of ACS patients hospitalized in five Swiss university hospitals was categorized into four educational levels (EL) with EL1 defined as lower than vocational school and EL4 as a university degree. The use of medical therapies, achievement of preventive targets and risk of clinical events were evaluated across ELs at baseline (N = 6040), 1-year (N = 5756) and 5-years (N = 2253) and presented with adjusted marginal odds ratios (mOR), average marginal effect (AME) and hazard ratios (HRs).</p><p><strong>Results: </strong>Among 6040 patients, the mean age was 63 years, and 81% were male. Participants with lower EL had a greater burden of cardiovascular risk factors at baseline. Compared with EL4 participants EL1 participants had lower adherence to cardiac rehabilitation (mOR = .6 [95% CI .5-.8], AME = -10%) and were less likely to be followed by a cardiologist (mOR .6 [95% CI .5-.8], AME = -6%). Use of medical therapies did neither differ across EL at discharge nor during follow-up. At 1 year, smoking cessation (mOR = .7 [95% CI .5-.9], AME = -10%) and weight reduction ≥5% among overweight or obese participants (mOR = .7 [95% CI .5-.9], AME = -6%) were less frequent in individuals with EL1 compared with EL4. At long term, achievement of LDL-C <1.8 mmol/L (<70 mg/dL) (mOR = .6 [95% CI .4-.9], AME = -9%) was less frequent in individuals with EL1 compared with EL4. 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引用次数: 0
摘要
背景：尽管普遍覆盖，但在急性冠脉综合征（ACS）护理方面仍然存在不公平现象。本研究探讨教育水平如何影响医疗保健的质量和结果。方法：在瑞士五所大学医院住院的ACS患者队列被分为四个教育水平（EL），其中EL1定义为低于职业学校，EL4定义为大学学历。在基线（N = 6040）、1年（N = 5756）和5年（N = 2253）对el的药物治疗使用情况、预防目标实现情况和临床事件风险进行评估，并给出调整后的边际优势比（more）、平均边际效应（AME）和风险比（hr）。结果：6040例患者中，平均年龄63岁，男性占81%。较低EL的参与者在基线时心血管危险因素负担更大。与EL4参与者相比，EL1参与者对心脏康复的依从性较低(more =。[95% ci .5]。[8], AME = -10%)，并且不太可能得到心脏病专家的随访(more or .6 [95% CI .5]。[8], ame = -6%)。在出院时和随访期间，使用药物治疗在EL之间没有差异。1年后，戒烟(more =。[95% ci .5]。[9], AME = -10%)，超重或肥胖参与者体重减轻≥5% (more or =。[95% ci .5]。[9], AME = -6%)在EL1患者中的发生率低于EL4患者。从长期来看，LDL-C的实现结论：在瑞士，ACS护理和结果在EL之间仍然存在差异，强调需要量身定制的干预措施来减少不平等。
Educational level, clinical outcomes and quality of care in a Swiss cohort of patients with acute coronary syndromes.
Background: Despite universal coverage, inequities persist in acute coronary syndrome (ACS) care. This study examines how educational levels impact the quality and outcomes of health care.
Methods: A cohort of ACS patients hospitalized in five Swiss university hospitals was categorized into four educational levels (EL) with EL1 defined as lower than vocational school and EL4 as a university degree. The use of medical therapies, achievement of preventive targets and risk of clinical events were evaluated across ELs at baseline (N = 6040), 1-year (N = 5756) and 5-years (N = 2253) and presented with adjusted marginal odds ratios (mOR), average marginal effect (AME) and hazard ratios (HRs).
Results: Among 6040 patients, the mean age was 63 years, and 81% were male. Participants with lower EL had a greater burden of cardiovascular risk factors at baseline. Compared with EL4 participants EL1 participants had lower adherence to cardiac rehabilitation (mOR = .6 [95% CI .5-.8], AME = -10%) and were less likely to be followed by a cardiologist (mOR .6 [95% CI .5-.8], AME = -6%). Use of medical therapies did neither differ across EL at discharge nor during follow-up. At 1 year, smoking cessation (mOR = .7 [95% CI .5-.9], AME = -10%) and weight reduction ≥5% among overweight or obese participants (mOR = .7 [95% CI .5-.9], AME = -6%) were less frequent in individuals with EL1 compared with EL4. At long term, achievement of LDL-C <1.8 mmol/L (<70 mg/dL) (mOR = .6 [95% CI .4-.9], AME = -9%) was less frequent in individuals with EL1 compared with EL4. Lower EL was associated with an increased risk of major acute coronary event (MACE) at short- (aHR = 1.4 [95% CI 1.0-2.0] for EL1 vs. EL4) and long term (aHR = 1.3 [95% CI 1.0-1.6] for EL1 vs. EL4) and all-cause death at long term (aHR = 1.6 [95% CI 1.1-2.2] for EL1 vs. EL4).
Conclusion: In Switzerland, disparities in ACS care and outcomes remain across EL, emphasising the need for tailored interventions to reduce inequities.
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EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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