Table 1.
Baseline characteristics of hospital survivors of an acute coronary syndrome according to the presence of specific barriers to healthcare access
| Characteristics | Financial barrier (n = 665) | No financial barrier (n = 1343) | P value | No usual Source of care (n = 343) | Usual source of care (n = 1665) | P value | Transportation barrier (n = 239) | No transportation barrier (n = 1769) | P value |
|---|---|---|---|---|---|---|---|---|---|
| Sociodemographic | |||||||||
| Age, mean, yrs. (SD) | 56.9 (10.2) | 63.9 (11.1) | < 0.001 | 56.3 (11.6) | 62.7 (10.9) | < 0.001 | 58.2 (10.9) | 62.0 (11.3) | < 0.001 |
| Female (%) | 39.7 | 29.9 | < 0.001 | 30.6 | 33.6 | 0.28 | 42.7 | 31.8 | 0.001 |
| Non-Hispanic White (%) | 68.4 | 80.8 | < 0.001 | 64.0 | 79.3 | < 0.001 | 59.8 | 79.0 | < 0.001 |
| Education (%) | |||||||||
| Less than high school | 21.8 | 15.1 | 25.9 | 15.6 | 34.7 | 15.0 | |||
| High school | 35.0 | 27.1 | 36.4 | 28.3 | 28.5 | 29.9 | |||
| Some college/post-high school | 29.0 | 28.6 | 22.4 | 30.1 | 25.5 | 29.2 | |||
| College graduate | 14.1 | 29.2 | < 0.001 | 15.2 | 26.1 | < 0.001 | 11.3 | 26.0 | < 0.001 |
| Living situation (%) | |||||||||
| With spouse | 39.8 | 53.2 | 33.0 | 52.0 | 23.9 | 52.1 | |||
| With family (non-spouse) | 22.6 | 12.6 | 24.6 | 14.1 | 26.4 | 14.5 | |||
| With non-family | 14.5 | 13.0 | 17.8 | 12.6 | 17.2 | 13.0 | |||
| Alone | 23.2 | 21.2 | < 0.01 | 24.6 | 21.3 | < 0.001 | 32.6 | 20.4 | < 0.001 |
| Employment status (%) | |||||||||
| Retired | 24.4 | 46.3 | 20.2 | 42.9 | 30.4 | 40.2 | |||
| Working | 40.4 | 40.8 | 45.8 | 39.6 | 19.8 | 43.5 | |||
| Unemployed | 35.2 | 12.9 | < 0.001 | 33.9 | 17.6 | < 0.001 | 49.8 | 16.3 | < 0.001 |
| Finances at end of month (%) | |||||||||
| Some left over | 19.5 | 59.8 | 33.8 | 48.9 | 14.4 | 50.7 | |||
| Just enough to make ends meet | 40.3 | 31.5 | 34.7 | 34.4 | 36.4 | 34.2 | |||
| Not enough to make ends meet | 40.3 | 8.7 | < 0.001 | 31.4 | 16.7 | < 0.001 | 49.2 | 15.2 | < 0.002 |
| Clinical | |||||||||
| GRACE score, mean (SD)* | 88.7 (26.4) | 99.4 (28.9) | < 0.001 | 88.7 (28.2) | 97.4 (28.4) | < 0.001 | 95.1 (27.6) | 96.0 (28.7) | 0.66 |
| Prior medical history (%) | |||||||||
| Arthritis | 17.1 | 21.5 | 0.02 | 14.9 | 21.1 | 0.01 | 23.0 | 19.7 | 0.23 |
| Cancer | 9.2 | 13.1 | 0.01 | 8.7 | 12.4 | 0.05 | 10.9 | 11.9 | 0.63 |
| Chronic lung disease | 20.5 | 17.1 | 0.07 | 20.4 | 17.8 | 0.26 | 26.4 | 17.1 | < 0.001 |
| Chronic kidney disease | 9.9 | 11.9 | 0.18 | 11.4 | 11.2 | 0.94 | 18.4 | 10.3 | < 0.001 |
| Diabetes | 38.8 | 30.2 | < 0.001 | 30.3 | 33.6 | 0.24 | 48.1 | 31.0 | < 0.001 |
| Heart disease | 56.7 | 51.0 | 0.02 | 50.4 | 53.4 | 0.32 | 69.0 | 50.7 | < 0.001 |
| Heart failure | 16.5 | 13.0 | 0.04 | 13.1 | 14.4 | 0.53 | 24.3 | 12.8 | < 0.001 |
| Hyperlipidemia | 68.0 | 69.8 | 0.41 | 58.6 | 71.4 | < 0.001 | 70.7 | 69.0 | 0.58 |
| Hypertension | 76.7 | 76.0 | 0.71 | 69.1 | 77.7 | < 0.001 | 85.8 | 74.9 | < 0.001 |
| Peripheral vascular disease | 9.6 | 10.0 | 0.80 | 9.3 | 10.0 | 0.72 | 18.4 | 8.7 | < 0.001 |
| Stroke/TIA | 8.6 | 9.7 | 0.42 | 9.3 | 9.3 | 0.99 | 13.8 | 8.7 | < 0.05 |
| Smoking Status (%) | |||||||||
| Never smoked | 25.6 | 32.8 | 23.0 | 32.0 | 19.2 | 31.9 | |||
| Former smoker | 40.6 | 48.7 | 35.6 | 48.2 | 43.9 | 46.4 | |||
| Current smoker | 33.8 | 18.4 | < 0.001 | 41.4 | 19.8 | < 0.001 | 36.8 | 21.7 | < 0.001 |
| ACS Type (%) | |||||||||
| STEMI | 10.7 | 17.1 | 13.4 | 15.3 | 10.0 | 15.7 | |||
| NSTEMI | 59.2 | 53.9 | 58.0 | 55.2 | 56.9 | 55.5 | |||
| UA | 30.1 | 29.0 | 0.01 | 28.6 | 29.5 | 0.55 | 33.1 | 28.8 | 0.04 |
| Reperfusion therapy (%) | |||||||||
| PCI | 66.5 | 65.5 | 62.4 | 66.5 | 61.9 | 66.3 | |||
| CABG surgery | 11.4 | 14.1 | 13.7 | 13.1 | 12.6 | 13.3 | |||
| No PCI nor CABG | 22.1 | 20.5 | 0.21 | 23.9 | 20.4 | 0.30 | 25.5 | 20.4 | 0.20 |
| In-hospital medications (%) | |||||||||
| ACEI/ARB | 63.6 | 60.5 | 0.18 | 61.2 | 61.6 | 0.89 | 65.7 | 61.0 | 0.16 |
| Aspirin | 95.8 | 96.8 | 0.26 | 97.1 | 96.3 | 0.48 | 92.9 | 97.0 | 0.004 |
| Beta-blocker | 90.1 | 90.3 | 0.90 | 93.6 | 89.5 | 0.03 | 92.5 | 89.9 | 0.19 |
| Lipid-lowering medication | 89.5 | 89.9 | 0.78 | 92.4 | 89.2 | 0.06 | 90.4 | 89.7 | 0.73 |
| Dual antiplatelet therapy | 81.2 | 80.5 | 0.70 | 81.6 | 80.5 | 0.64 | 79.9 | 80.8 | 0.74 |
| Length of stay ≥ 3 days (%) | 54.6 | 50.9 | 0.12 | 58.0 | 50.9 | 0.02 | 63.2 | 50.6 | < 0.001 |
| Psychosocial | |||||||||
| Health literacy (%) | |||||||||
| High | 58.2 | 66.4 | 58.0 | 64.8 | 46.4 | 66.0 | |||
| Medium | 18.9 | 17.3 | 18.3 | 17.7 | 25.5 | 16.8 | |||
| Low | 23.0 | 16.3 | < 0.001 | 23.7 | 17.5 | < 0.01 | 28.1 | 17.2 | < 0.001 |
| Cognitive status (%) | |||||||||
| Normal | 45.4 | 52.4 | 40.4 | 52.1 | 35.3 | 52.0 | |||
| Ambiguous | 45.4 | 41.6 | 47.6 | 41.8 | 48.7 | 42.1 | |||
| Mildly or severely impaired | 9.3 | 6.1 | < 0.005 | 12.0 | 6.1 | < 0.001 | 16.1 | 6.0 | < 0.001 |
| Depressive symptoms (%) | |||||||||
| Absent | 33.7 | 59.2 | 48.7 | 51.3 | 24.4 | 54.4 | |||
| Minor | 30.4 | 24.8 | 20.9 | 27.8 | 26.5 | 26.7 | |||
| Moderate | 18.0 | 11.2 | 15.2 | 13.1 | 23.1 | 12.1 | |||
| Moderately severe to severe | 17.9 | 4.9 | < 0.001 | 15.2 | 7.9 | < 0.001 | 26.1 | 6.8 | < 0.001 |
| Anxiety Symptoms (%) | |||||||||
| Absent | 34.8 | 59.0 | 46.5 | 51.9 | 22.5 | 54.9 | |||
| Mild | 28.8 | 23.2 | 24.3 | 25.2 | 28.4 | 24.6 | |||
| Moderate | 16.2 | 10.9 | 12.3 | 12.7 | 22.9 | 11.2 | |||
| Severe | 20.3 | 6.9 | < 0.001 | 17.0 | 10.1 | 0.001 | 26.3 | 9.3 | < 0.001 |
ACEI, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin II receptor blocker; GRACE, Global Registry of Acute Coronary Events; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; TIA, transient ischemic attack; UA, unstable angina
Missing data: cognitive status (n = 41), depressive symptoms (n = 44) employment status (n = 20), finances at the end of month (n = 36), GRACE risk score (n = 39), health literacy (n = 9), living situation (n = 2), race/ethnicity (n = 2)
*GRACE risk scores (2.0) incorporate data on age, cardiac biomarkers, ST segment changes, systolic blood pressure, creatinine or history of renal dysfunction, Killip class or use of diuretics, and the development of cardiac arrest during the index hospitalization to calculate risk for mortality at 1 and 3 years after admission for an ACS. It is scored on a scale from 0 to 263, with higher scores indicating a higher probability of death