Cardiovascular Disease, Myocardial Infarction, Secondary Prevention, Socioeconomic Status, Stroke
Conditions
Brief summary
This is a nationwide cohort study on real-world patients (n≈30,000) surviving a first myocardial infarction (MI) 2006-2013 and alive to attend a routine 1-year follow-up. Associations between Socioeconomic Status (SES) and secondary preventive actions (SPAs) throughout the first year is studied and assessed as possible mechanisms underlying the increased risk of a first recurrent hard cardiocvascular (CV) outcome, recurrent atherosclerotic cardiovascular disease (rASCVD), in patients with low Socioeconomic Status during long-term follow-up (2006-2018).
Interventions
None listed
Sponsors
Karolinska Institutet
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 76 Years
Inclusion criteria
* Swedish resident * Alive and registered in The Swedish Websystem for Enhancement and Development of Evidence based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART)'s secondary prevention subregistry between 1 January 2006 and 31 December 2013 at the 1-year-revisit
Exclusion criteria
* Age \>76 years at baseline * Missing data for disposable household income * History of MI, stroke, coronary artery bypass graft (CABG), or percutaneous coronary intervention (PCI) prior to the index MI * Not present in initial care registry (RiksHIA) * Date of index MI before 2004 or missing * revisit outside 13±2 month window post-MI
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| first recurrent atherosclerotic cardiovascular disease event (rASCVD) | from date of 1-year visit post-MI (baseline) until date of outcome, censoring or study end (2018) | composite outcome including non-fatal MI (I210-I214, I219, I220, I221, I228 or I229) or coronary heart disease death (CHD) (I210-I214, I219, I220, I221, I228, I229, I461 or I469) or fatal or non-fatal ischemic stroke (I630-I635, I638 or I639) according to the International Classification of Diseases 10th edition (ICD-10) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Goal: LDL-C goal | at 1-year revisit | attained LDL-C level below treatment target |
| Goal: Blood pressure goal | at 1-year revisit | attained blood pressure levels below treatment target |
| Goal: smoking cessation | at 1-year revisit | Patients being current smokers at their initial care who successfully quit smoking. |
| Goal: physical activity | at 1-year revisit | reported \>30 minutes of physical activity ≥5 times a week |
| Goal: statin treatment | at 1-year revisit | on statin treatment 1 year after the index MI |
| Goal: Renin-angiotensin-aldosteron system (RAAS)-inhibition | at 1-year revisit | Patients with congestive heart failure, diabetes or hypertension at the index Mi on treatment with angiotensin converting enzyme inhibitor or angiotensin receptor blocker. |
| Goal: HbA1c goal | at 1-year revisit | Patients with diabetes with attained HbA1c treatment target |
| SPA: cardiac rehabilitation program | during 1st year after initial care | participation in structured program after the index MI |
| SPA: diet course | during 1st year after initial care | participation in course after the index MI |
| SPA: statin intensity increase | 2 months or 1 year after initial care | statin intensity increase decided at routine revisits (Dosages categorized into high (Rosuvastatin 20-40 mg or Atorvastatin 40-80 mg), moderate (Rosuvastatin 5-10 mg, Atorvastatin 10-20 mg, or Simvastatin 20-40 mg) and low (Simvastatin 10 mg)) |
| Goal: physical training program | at 1-year revisit | participated in organized physical training program after the initial care |
| SPA: LDL-C reduction | 2 months and 1 year after initial care | LDL-C reduction between routine revisits |
| SPA: lipid monitoring | 2 months or 1 year after initial care | Blood lipid panel measured |
| SPA: type of follow-up | 2 month revisit | decided follow-up by office revisit or by phone |
| SPA: reperfusion | initial care | type of reperfusion treatment chosen in STEMI and NSTEMI |
| SPA: revascularized | initial care | achieved complete revascularization in STEMI and NSTEMI |
| SPA: staged procedure | initial care | Decision on continued invasive procedures at a later stage |
| SPA: smoking cessation counseling | 2 months or 1 year after initial care | received through cessation program or counseling |
| SPA: HbA1c monitoring | during initial care, at 2 months and 1 year after initial care | Patients with diabetes at initial care having their HbA1c measured at least twice |
| SPA: Anti-stress program | 1 year after initial care | Patients reporting anxiety or sadness participating in anti-stress program |
| SPA: counter-metabolic syndrome actions | 2 months or 1 year after initial care | Patients with the metabolic syndrome participating in physical training and diet course or in cardiac rehabilitation program |
| SPA: high intensity statins | at 1-year revisit | on high intensity statin treatment (Rosuvastatin 20-40 mg or Atorvastatin 40-80 mg) |
Outcome results
None listed