The impact of secondary prevention initiatives on survival in higher-risk socioeconomically
disadvantaged patients after acute myocardial infarction (AMI) may depend on behavioral
adaptive responsiveness, uptake, and adherence to healthier lifestyles. From December
1999 to February 2003, 1,801 patients in Ontario, Canada were interviewed regarding
their lifestyle behaviors at 30 days after their index AMI hospitalization. Data were
obtained using self-reported surveys, medical chart abstraction, and administrative
data linkage. Multivariate analyses were adjusted for baseline sociodemographic, cardiac
risk severity, and co-morbid conditions. Socioeconomically disadvantaged patients
had greater cardiac risk severity at baseline than did their wealthier better-educated
counterparts. Compared with lower-income patients, patients with higher incomes were
less likely to smoke (adjusted odds ratio [OR] for highest vs lowest income tertiles
0.36, 95% confidence interval [CI] 0.21 to 0.63, p <0.001), more likely to participate
in exercise (adjusted OR 1.40, 95% CI 1.07 to 1.85, p = 0.02), and more likely to
decrease or discontinue alcohol use (adjusted OR 1.64, 95% CI 1.16 to 2.34, p = 0.06).
The relation between education and lifestyle behaviors was less pronounced for education
than for income. After adjustment for baseline factors, patients who acknowledged
participation in regular physical exercise at 1 month had a significantly lower long-term
mortality than those who did not. In conclusion, socioeconomically disadvantaged patients
were sicker at baseline and less behaviorally responsive to embarking on healthy lifestyle
changes after AMI than were those of higher socioeconomic status.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Coronary interventions and their impact on post myocardial infarction survival.Clin Cardiol. 2005; 28: I38-I44
- Practical algorithms for pharmacologic management of the post myocardial infarction patient.Clin Cardiol. 2005; 28: I28-I37
- Smoking habits and predictors of continued smoking in patients with acute coronary syndromes.J Adv Nurs. 2004; 46: 614-623
- A systematic review of interventions to improve diabetes care in socially disadvantaged populations.Diabetes Care. 2006; 29: 1675-1688
- Predictors of smoking cessation after coronary artery bypass graft surgery.Ann Intern Med. 1994; 120: 287-293
- Risk factor modification after myocardial infarction.Ann Intern Med. 1988; 109: 213-218
- Socioeconomic status, service patterns, and perceptions of care among survivors of acute myocardial infarction in Canada.JAMA. 2004; 291: 1100-1107
- Effective prevention of carotid artery atherosclerosis by following this motto for healthy habits: “Give up one, reduce two, and increase three.”.Methods Inf Med. 2005; 44: 319-322
- Socioeconomic status and mortality after acute myocardial infarction.Ann Intern Med. 2006; 144: 82-93
- A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry.JAMA. 2004; 291: 2727-2733
- Evaluating the performance of the Global Registry of Acute Coronary Events risk-adjustment index across socioeconomic strata among patients discharged from the hospital after acute myocardial infarction.Am Heart J. 2006; 151: 323-331
- Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults.CMAJ. 2000; 162: S13-S24
- The contribution of lifestyle factors to socioeconomic differences in obesity in men and women—a population-based study in Sweden.Eur J Epidemiol. 2003; 18: 227-234
- Social class and health behaviour in Danish adults: a longitudinal study.Public Health. 1993; 107: 251-260
- Diet and eating habits in high and low socioeconomic groups.Nutrition. 2005; 21: 559-566
- Barriers and motivators to gaining access to smoking cessation services amongst deprived smokers—a qualitative study.BMC Health Serv Res. 2006; 6: 147
- Vulnerability and unmet health care needs.J Gen Intern Med. 2005; 20: 148-154
- Physician visits, hospitalizations, and socioeconomic status: ambulatory care sensitive conditions in a Canadian setting.Health Serv Res. 2005; 40: 1167-1185
- The association between educational level and risk of cardiovascular disease fatality among women with cardiovascular disease.Womens Health Issues. 2005; 15: 80-88
- Relationship of socioeconomic status with cardiovascular risk factors and lifestyle in a Mediterranean population.Eur J Nutr. 2004; 43: 77-85
- Education and income: double-edged swords in the epidemiologic transition of cardiovascular disease.Ethn Dis. 2003; 13: S158-S163
- A life-course approach in explaining social inequity in obesity among young adult men and women.Int J Obes (Lond). 2006; 30: 191-200
- Socioeconomic disparities in outcomes after acute myocardial infarction.Am Heart J. 2007; 153: 313-319
- Why do poor people behave poorly?.Soc Sci Med. 1997; 44: 809-819
- The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review.Am J Prev Med. 1999; 17: 211-229
- Validity of residents' self-reported cardiovascular disease prevention activities: the Preventive Medicine Attitudes and Activities Questionnaire.Prev Med. 2000; 31: 241-248
- Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?.Am J Epidemiol. 1996; 144: 934-942
- An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas.Am J Public Health. 1997; 87: 1156-1163
- Going back to understand the future: socioeconomic position and survival after myocardial infarction.Ann Intern Med. 2006; 144: 137-139
Article Info
Publication History
Published online: October 13, 2008
Accepted:
August 2,
2008
Received in revised form:
August 2,
2008
Received:
June 6,
2008
Footnotes
The Socio-Economic and Acute Myocardial Infarction (SESAMI) study is supported by an operating grant from the Canadian Institutes of Health Research. The SESAMI pilot study was supported by the 1988 Michael Smith Award of Excellence from the Medical Research Council of Canada. The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health. Dr. Alter is a career investigator with the Heart and Stroke Foundation of Ontario and the chief scientific officer of Intervent Canada (PrevCan), a therapeutic lifestyle and disease-management program; Dr. Gordon is the chief medical and scientific officer of Nationwide Better Health, Savannah, Georgia.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
