title: Impact of income status on prognosis of acute coronary syndrome patients during Greek financial crisis.
abstract: BACKGROUND
  The effect of income status on patient outcome merits investigation during periods of financial crisis. We evaluated the impact of income status on out-of-hospital prognosis in a cohort of acute coronary syndrome (ACS) patients, included in a countrywide study during a period of financial crisis.
  
  
  METHODS
  The study is a secondary analysis of a prospective, multicenter, observational study-the PHAETHON study-enrolling consecutive ACS patients in 37 hospitals in Greece. Patients were classified as low or high income based on the reported net annual household income using as a cut-off point the relative poverty threshold for Greece of 12,000 Euros. The outcome measure was survival free of the primary composite endpoint (cardiovascular death, myocardial infarction, stroke/transient ischemic attack, urgent revascularization and urgent hospitalization due to cardiovascular causes).
  
  
  RESULTS
  The study population included 794 patients. The administration rate of evidence-based medications was similar in the low- (n = 455) and high-income (n = 339) groups during hospitalization and upon discharge. In a median follow-up of 189 days (interquartile range: 180-212 days), low-income patients had 92 % higher risk of the combined endpoint as compared to high-income patients [Hazard ratio (HR):1.92, 95 % CI:1.25-2.94, p = 0.003]. The effect of low-income status on the combined outcome remained significant after adjustment for age, gender and depression (HR:1.59, 95 % CI:1.02-2.49; p = 0.043).
  
  
  CONCLUSIONS
  In a period of financial crisis, low income is a significant and independent predictor of poor out-of-hospital outcome in ACS patients. This association has profound implications and should be taken into consideration by public health policy makers.
authors.affiliation: Henry Dunant Hospital Center Athens, 18 Parmenionos Street, 13676, Thrakomakedones, Greece. andrikop@hotmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Andrikopoulos
authors.affiliation: Henry Dunant Hospital Center Athens, 18 Parmenionos Street, 13676, Thrakomakedones, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tzeis
authors.affiliation: Hippokration Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Terentes-Printzios
authors.affiliation: Attikon University Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Varounis
authors.affiliation: Hippokration Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Vlachopoulos
authors.affiliation: General Hospital of Halkida, Chalkida, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mantas
authors.affiliation: Konstantopoulio General Hospital, Athens, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Patsilinakos
authors.affiliation: Bodosakeio General Hospital of Ptolemaida, Ptolemaida, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Lampropoulos
authors.affiliation: Thriassio General Hospital, Athens, Greece.
authors.forename: Christoforos
authors.initials: C
authors.lastname: Olympios
authors.affiliation: Skylitsion General Hospital of Chios, Chios, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Kartalis
authors.affiliation: Asklipio General Hospital of Voula, Voula, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Manolis
authors.affiliation: General Hospital of Komotini, Komotini, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Gotsis
authors.affiliation: University Hospital of Larissa, Larissa, Greece.
authors.forename: Filippos
authors.initials: F
authors.lastname: Triposkiadis
authors.affiliation: Achilopouleio General Hospital of Volos, Volos, Greece.
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Tsaknakis
authors.affiliation: University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Goudevenos
authors.affiliation: Papageorgiou General Hospital, Pavlos melas, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kaprinis
authors.affiliation: General Hospital of Chania, Mournies, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Pras
authors.affiliation: General Hospital Larissa, Larissa, Greece.
authors.forename: Fotios
authors.initials: F
authors.lastname: Vasiliou
authors.affiliation: General Hospital of Thiva, Thiva, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Skoumpourdis
authors.affiliation: General Hospital of Preveza, Preveza, Greece.
authors.forename: Gerasimoula
authors.initials: G
authors.lastname: Sakka
authors.affiliation: General Hospital of Corfu, Corfu, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Draganigos
authors.affiliation: University Hospital of Heraklion, Heraklion, Greece.
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D018572:Disease-Free Survival; D057172:Economic Recession; D005260:Female; D006115:Greece / Q000453:epidemiology; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007182:Income; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000191:economics; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011634:Public Health / Q000191:economics*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Financial crisis; Income; Prognosis