教育水平和冠状动脉计算机断层扫描、功能测试、冠状动脉造影、血运重建和结果的使用——一项为期10年的丹麦全国性注册随访研究。

IF 4.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Quality of Care and Clinical Outcomes Pub Date : 2024-06-20 DOI:10.1093/ehjqcco/qcad052

Marc Meller Søndergaard, Phillip Freeman, Anna Meta Dyrvig Kristensen, Su Min Chang, Khurram Nassir, Martin Bødtker Mortensen, Bjarne Linde Nørgaard, Michael Maeng, Mikkel Porsborg Andersen, Peter Søgaard, Bhupendar Tayal, Manan Pareek, Søren Paaske Johnsen, Lars Køber, Gunnar Gislason, Christian Torp-Pedersen, Kristian Hay Kragholm

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引用次数: 0

摘要

背景和目的：冠状动脉计算机断层摄影血管造影术（CCTA）可以指导下游预防性治疗并改善患者预后，但其与教育水平的关系仍有待探索。方法：这项基于登记的全国性队列研究评估了2008-2018年间丹麦所有没有冠状动脉疾病（CAD）和50-80岁的居民（n=1469724）。居民按照四个教育水平进行划分：低、初中、高中和高中。结果包括CCTA、功能测试、有创冠状动脉造影（ICA）、血运重建、，结果：受教育程度最低的个体接受CCTA的频率（绝对风险[AR]3.95%，年龄≥50-59岁的个体，AR3.62%，年龄≥70-80岁的个体）低于中下部个体（AR4.16%，AR3.90%，AR2.41%），中等偏上（4.38%、4.30%、2.45%）和最高教育水平（3.98%、4.37%、2.30%）。在功能测试中观察到类似的差异。相反，ICA的使用、血运重建和MACCE的风险在教育水平最低的个体中更常见。在接受CCTA检查的患者中（n=50234），受教育程度最低的患者较少接受功能测试，更有可能开始预防性药物治疗，接受ICA、血运重建和MACCE。结论：尽管丹麦的医疗保健由税收资助，受教育程度最低的人比受教育程度较高的人不太可能接受CCTA和功能测试。教育水平最低的个体ICA利用率、血运重建和MACCE风险较高。在接受CCTA检查的患者中，与教育水平较高的组相比，教育水平最低的患者更有可能开始预防性药物治疗，并且血运重建和MACCE的风险最高。这些发现表明，CCTA的预防潜力在教育水平较低的个体中没有得到充分利用，而教育水平是社会经济地位的代表。如果没有税收资助的医疗保健，CAD评估、护理和结果方面的社会经济差异可能会更大。

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Education level and the use of coronary computed tomography, functional testing, coronary angiography, revascularization, and outcomes-a 10-year Danish, nationwide, registry-based follow-up study.

Background and aims: Coronary computed tomography angiography (CCTA) can guide downstream preventive treatment and improve patient prognosis, but its use in relation to education level remains unexplored.

Methods: This nationwide register-based cohort study assessed all residents in Denmark between 2008 and 2018 without coronary artery disease (CAD) and 50-80 years of age (n = 1 469 724). Residents were divided according to four levels of education: low, lower-mid, higher-mid, and high. Outcomes were CCTA, functional testing, invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE).

Results: Individuals with the lowest education level underwent CCTA (absolute risk [AR] 3.95% individuals aged ≥50-59, AR 3.62% individuals aged ≥60-69, and AR 2.19% individuals aged ≥70-80) less often than individuals of lower-mid (AR 4.16%, AR 3.90%, and AR 2.41%), higher-mid (AR 4.38%, AR 4.30%, and AR 2.45%) and highest education level (AR 3.98%, AR 4.37%, and AR 2.30%). Similar differences were observed for functional testing. Conversely, use of ICA, and risks of revascularization and MACCE were more common among individuals of lowest education level. Among patients examined with CCTA (n = 50 234), patients of lowest education level less often underwent functional testing and more likely initiated preventive medication, underwent ICA, revascularization, and experienced MACCE.

Conclusion: Despite tax-financed healthcare in Denmark, individuals of lowest education level were less likely to undergo CCTA and functional testing than persons of higher education level. Invasive coronary angiography utilization, revascularization, and MACCE risks were higher for individuals of lowest education level. Among CCTA-examined patients, patients of lowest education level were more likely to initiate preventive medication and had the highest risks of revascularization and MACCE when compared to higher education level groups. These findings suggest that the preventive potential of CCTA is underutilized in individuals of lower education level, a proxy for socioeconomic status. Socioeconomic differences in CAD assessment, care, and outcomes are likely even larger without tax-financed healthcare.

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来源期刊

European Heart Journal - Quality of Care and Clinical Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

3.80%

发文量

期刊介绍： European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.