title: Lower Financial Status and Adherence to Medication Determines 10-Year (2004-2014) All-Cause Mortality and Risk for Acute Coronary Syndrome Incidence Among Cardiac Patients: the GREECS Study.
abstract: BACKGROUND
  Financial status has been considered as an important health determinant and associated with compliance to healthier lifestyle habits, medical treatment and increased prevalence of mental disorders. The aim of this work was to evaluate the association between financial status, patient adherence to medication, 10-year allcause mortality and risk for Acute Coronary Syndrome (ACS), in a Greek sample of cardiac patients.
  
  
  METHODS
  From October 2003-September 2004 a sample of 2,172 consecutive ACS patients from 6 hospitals was enrolled. In 2013-14, the 10-year follow-up was performed in 1,918 participants. Adherence to medical treatment was recorded through self-reports and financial status was classified as low (<9,000€), moderate (9-18,000€), good (19-48,000€) and very good (>48,000€).
  
  
  RESULTS
  The "low"-to-"very" good financial status 10-year all-cause mortality rate was 1.7:1 (p<0.001). Unadjusted analysis revealed no association between financial status and ACS incidence (p=0.22); however, multi-adjusted analysis, after taking into account various clinical and lifestyle factors, revealed that "good/very good" financial status was associated with 23% (95%CI 2%, 40%, p=0.04) lower 10-year risk of ACS as compared with "low/moderate"; a finding that became insignificant when adherence to medication was taken into account.
  
  
  CONCLUSIONS
  Low financial status seems to play a critical role in the long-term ACS prognosis. Health policies, to tackle non-compliance to medication, are needed to minimize the disease burden in clinical and community settings.
authors.forename: Venetia
authors.initials: V
authors.lastname: Notara
authors.affiliation: FRSPH, FACE 46 Paleon Polemiston St. 166 74, Glyfada, Greece. d.b.panagiotakos@usa.net.
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
authors.forename: Yannis
authors.initials: Y
authors.lastname: Kogias
authors.forename: Petros
authors.initials: P
authors.lastname: Stravopodis
authors.forename: George
authors.initials: G
authors.lastname: Papanagnou
authors.forename: Spyros
authors.initials: S
authors.lastname: Zombolos
authors.forename: Yannis
authors.initials: Y
authors.lastname: Mantas
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006115:Greece; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors