Poor patients twice as likely to die from heart disease

ATLANTA In the first analysis of its kind, Duke University Medical Center researchers have shown that the poorest of poor Americans are more than twice as likely to die of severe heart disease than similar patients with higher incomes. Furthermore, it may be that the main explanation comes from what happens in these patients lives after hospital discharge.

The researchers studied 2,207-patients enrolled in a multi-center clinical trial in which they all received the same standardized treatments. The analysis revealed that patients with an annual household income of less than $10,000 had a 30-day mortality rate 2.6 times higher than those more well off, and a six-month mortality rate 2.1 times higher.

In a clinical trial, patients are supposed to receive similar care, but actually did not, said lead investigator Sunil Rao, M.D., who prepared the results of the Duke study for presentation today (March 17) at the 51st annual scientific sessions of the American College of Cardiology. Despite the standardization of many treatments, poverty was associated with a lower rate of some evidence-based medications at the time of hospital discharge and lower rate of some procedures during the hospitalization.

After adjusting for these differences, poverty was still associated with a generally worse outcome, suggesting that the situation these patients return to may be responsible, he continued. It may be that once out of the hospital, these patients return to risky habits such as smoking or bad diet, or more likely they cannot afford the medications prescribed for them to treat their heart disease.

Their findings raise important health-care policy issues, the researchers say, since most of the very poor tend to be elderly. In the current analysis, the average age of the low-income group was 65.

The elderly, whose numbers continue to grow, are those who are the most impacted by heart disease, Rao continued. They keep coming to the hospital

Contact: Richard Merritt
Duke University

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