Use of statins (HR 0.57; 95% CI 0.53-0.61), RAAS inhibitors (HR 0.78), and platelet inhibitors (HR 0.74) was associated with reduced long-term mortality after CABG irrespective of socioeconomic status.
Cohort (n=28,448)
Sí
Does the use of secondary prevention medications improve long-term survival after CABG across different socioeconomic groups?
Underusage of secondary prevention medications after CABG is more common in low-income patients and is associated with increased long-term mortality independently of socioeconomic status.
Estimación del efecto: HR 0.57 (statins), HR 0.78 (RAAS inhibitors), HR 0.74 (platelet inhibitors) (95% CI 0.53-0.61 (statins), 0.73-0.84 (RAAS inhibitors), 0.68-0.80 (platelet inhibitors))
Background Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long-term survival in CABG patients with a low income and short education. Methods and Results Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population-based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β-blockers, and RAAS inhibitors), socioeconomic factors, patient characteristics, comorbidity, and long-term mortaity were merged. All-cause mortality risk was estimated using multivariable Cox regression models adjusted for patient characteristics, baseline comorbidities, time-updated secondary prevention medications, and socioeconomic status. Long-term mortality was higher in patients with a low income and short education. Statins and platelet inhibitors were dispensed less often to patients with a low income, both at baseline and after 8 years. The decline in dispensing over time was steeper for low-income patients. Short education was not associated with reduced dispensing of any secondary prevention medication. Use of statins (adjusted hazard ratio=0.57 95% CI, 0.53-0.61), RAAS inhibitors (adjusted hazard ratio=0.78 0.73-0.84), and platelet inhibitors (adjusted hazard ratio=0.74 0.68-0.80) were associated with reduced long-term mortality irrespective of socioeconomic status. Conclusions Secondary prevention medications are dispensed less often after CABG to patients with low income. Underusage of secondary prevention medications after CABG is associated with increased mortality risk independently of income and extent of education.
Nielsen et al. (Mon,) conducted a cohort in Coronary artery bypass grafting (CABG) (n=28,448). Secondary prevention medications (statins, platelet inhibitors, β-blockers, RAAS inhibitors) vs. Non-use or lower use was evaluated on All-cause mortality (HR 0.57 (statins), HR 0.78 (RAAS inhibitors), HR 0.74 (platelet inhibitors), 95% CI 0.53-0.61 (statins), 0.73-0.84 (RAAS inhibitors), 0.68-0.80 (platelet inhibitors)). Use of statins (HR 0.57; 95% CI 0.53-0.61), RAAS inhibitors (HR 0.78), and platelet inhibitors (HR 0.74) was associated with reduced long-term mortality after CABG irrespective of socioeconomic status.