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.