Socioeconomic disparities among patients hospitalized for acute myocardial infarction: insights from the FAST-MI 2015 registry
A Trimaille, C Bouleti, T Simon, Y Cottin, G Cayla, D Angoulvant, W Amara, R Cador, J Ferrieres, F Schiele, N DanchinAbstract
Background
Socioeconomic disparities persist and may impact both the implementation of recent therapeutic advances in the early management of acute myocardial infarction (AMI) and long-term outcomes. While area-level deprivation has been linked to AMI incidence and short-term mortality, contemporary nationwide data from European healthcare systems remain limited, particularly as regards long-term outcomes.
Purpose
To evaluate the association between area-level socioeconomic deprivation and long-term mortality following AMI in a large nationwide multicentre French cohort.
Methods
We analysed data from the 2015 FAST-MI registry, including 5,291 patients admitted for AMI to cardiac intensive care units in 204 centres across metropolitan France (78% of French centres managing AMI patients). Socioeconomic status was assessed using the French Deprivation Index (FDep), an ecological index derived from four municipality-level sociodemographic variables and categorised into quintiles (Q1: least deprived; Q5: most deprived). Baseline characteristics and in-hospital management were compared across FDep quintiles using ANOVA or χ² tests as appropriate. Long-term survival was analysed using Kaplan-Meier method and multivariable Cox regression.
Results
Among 5,104 patients (96.5%) with available FDep, prevalence of FDep quintile 1, 2, 3, 4 and 5 was 28%, 21%, 16%, 16%, and 19%, respectively. Higher deprivation was associated with a higher body mass index (p=0.027), a greater prevalence of diabetes (p=0.007) and current smoking (p=0.044) (Table 1, for readability, only Q1 and Q5 are displayed). No significant differences were observed across FDep quintiles with respect to other baseline demographic characteristics, cardiovascular risk factors, or prior medical history, although direct comparisons between Q1 and Q5 could differ. Patients from more deprived areas were less frequently admitted to university hospitals (p<0.001), and were more likely to receive thrombolysis (p=0.013). In STEMI patients (N=2,520, 49%), both symptom-to-angiography and ECG-to-angiography times increased with deprivation (p<0.001). In-hospital mortality and discharge medications were similar across quintiles. Over an 8-year follow-up, patients in the most deprived quintile had higher long-term mortality after multiple adjustment (HR 1.43, 95% CI 1.22-1.67; p<0.001, Figure 1).
Conclusions
In a large multicentre AMI cohort within a universal healthcare system, area-level socioeconomic deprivation was independently associated with higher long-term mortality. These findings suggest that social gradients in outcomes persist beyond acute management. They underscore the need for targeted preventive strategies and long-term follow-up interventions focused on socially disadvantaged populations to reduce residual inequalities in cardiovascular risk and improve post-AMI prognosis.Figure 1