Factors Associated with Mortality following Acute Coronary Syndrome According to Patient Satisfaction

Background: The factors associated with mortality following acute coronary syndrome (ACS) based on patient satisfaction are unknown. The objective was to describe and compare factors associated with 1-year mortality following ACS according to high versus low patient satisfaction with hospital stay, doctors, and nurses. Materials and Methods: In a registry of 3565 patients presenting with ACS to 29 hospitals across 4 countries, we grouped patients by self-reported satisfaction with hospital stay reported at 1-month following ACS. The primary outcome was all-cause 1-year mortality following ACS, excluding patients with mortality before the initial 30-day follow-up. We examined associations of patient and hospitalization factors with risk of 1-year all-cause mortality in logistic regression models, unadjusted and adjusted for Global Registry of Acute Coronary Event (GRACE) risk score, reported as odds ratio (OR; 95% confidence interval). Results: In models adjusting for GRACE risk score, in the low satisfaction category, women, compared with men, had statistically similar odds of mortality (adjusted OR: 1.43 [0.99–2.04]). Lack of formal education (vs. any education) was associated with higher odds of mortality in the low satisfaction (aOR: 1.99 [1.33–3.04]; P < 0.01) and high satisfaction (aOR: 3.06 [1.93–5.00]; P < 0.001) categories ( P interaction = 0.30). Lack of employment (vs. employment) was associated with similar higher odds of mortality in the low satisfaction (aOR: 6.37 [2.83–18.25]; P < 0.001) and high satisfaction (aOR: 2.58 [1.40–5.21]; P < 0.01) categories ( P interaction = 0.08). Generally comparable results were obtained when analyzed by patient satisfaction with doctors and with nurses. Conclusions: Education and employment were major factors associated with higher 1-year mortality following ACS, independent of patient satisfaction, and may inform tailored educational and outreach interventions to reduce mortality.