Education level and the use of coronary computed tomography, functional testing, coronary angiography, revascularization, and outcomes-a 10-year Danish, nationwide, registry-based follow-up study.

Autor:	Søndergaard MM; Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark., Freeman P; Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark., Kristensen AMD; Department of Cardiology, Bispebjerg and Frederiksberg Hospital, 2400, Denmark., Chang SM; Houston Methodist DeBakey Heart and Vascular Center, Cardiac Imaging Laboratory, 77030 Houston, TX, USA., Nassir K; Houston Methodist DeBakey Heart and Vascular Center, Preventive Cardiology, 77030 Houston, TX, USA., Mortensen MB; Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark., Nørgaard BL; Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark., Maeng M; Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark., Andersen MP; Department of Cardiology, Nordsjaellands Hospital, 3400 Hillerød, Denmark., Søgaard P; Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark., Tayal B; Department of Cardiology, Houston Methodist Hospital, 77030 Houston, TX, USA., Pareek M; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900, Denmark.; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, 2100, Denmark., Johnsen SP; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark., Køber L; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, 2100, Denmark., Gislason G; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark., Torp-Pedersen C; Department of Cardiology, Nordsjaellands Hospital, 3400 Hillerød, Denmark.; Department of Public Health, University of Copenhagen, 1353, Denmark., Kragholm KH; Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark.; Houston Methodist DeBakey Heart and Vascular Center, Cardiac Imaging Laboratory, 77030 Houston, TX, USA.; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, 9000 Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
Jazyk:	angličtina
Zdroj:	European heart journal. Quality of care & clinical outcomes [Eur Heart J Qual Care Clin Outcomes] 2024 Jun 20; Vol. 10 (4), pp. 294-304.
DOI:	10.1093/ehjqcco/qcad052
Abstrakt:	Background and Aims: Coronary computed tomography angiography (CCTA) can guide downstream preventive treatment and improve patient prognosis, but its use in relation to education level remains unexplored. Methods: This nationwide register-based cohort study assessed all residents in Denmark between 2008 and 2018 without coronary artery disease (CAD) and 50-80 years of age (n = 1 469 724). Residents were divided according to four levels of education: low, lower-mid, higher-mid, and high. Outcomes were CCTA, functional testing, invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE). Results: Individuals with the lowest education level underwent CCTA (absolute risk [AR] 3.95% individuals aged ≥50-59, AR 3.62% individuals aged ≥60-69, and AR 2.19% individuals aged ≥70-80) less often than individuals of lower-mid (AR 4.16%, AR 3.90%, and AR 2.41%), higher-mid (AR 4.38%, AR 4.30%, and AR 2.45%) and highest education level (AR 3.98%, AR 4.37%, and AR 2.30%). Similar differences were observed for functional testing. Conversely, use of ICA, and risks of revascularization and MACCE were more common among individuals of lowest education level. Among patients examined with CCTA (n = 50 234), patients of lowest education level less often underwent functional testing and more likely initiated preventive medication, underwent ICA, revascularization, and experienced MACCE. Conclusion: Despite tax-financed healthcare in Denmark, individuals of lowest education level were less likely to undergo CCTA and functional testing than persons of higher education level. Invasive coronary angiography utilization, revascularization, and MACCE risks were higher for individuals of lowest education level. Among CCTA-examined patients, patients of lowest education level were more likely to initiate preventive medication and had the highest risks of revascularization and MACCE when compared to higher education level groups. These findings suggest that the preventive potential of CCTA is underutilized in individuals of lower education level, a proxy for socioeconomic status. Socioeconomic differences in CAD assessment, care, and outcomes are likely even larger without tax-financed healthcare. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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