Transcript Quality of care

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Conor O'Shea, MD
Research Fellow
Department of Cardiology
Duke University
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GUSTO III data analyses
Data analysis was carried out on more
than 10 000 patient records drawn from
GUSTO III between 1994 and 1995.
Educational level was determined based
on whether a patient had attended
university, college, or high school.
Educational definitions were normalized
for different regions of the world.
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Mortality and education level
Analysis found a strong inverse correlation
between mortality at 1 year post-MI and
the number of years of education.
Patients with < 8 years of education (the
least amount) had a mortality rate
> 19% at 1 year.
Patients with > 16 years education had a
mortality rate of 3.5%.
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Regional differences in mortality
Data were analyzed from countries with
more than 500 patients enrolled (9
countries altogether).
The difference in mortality between those
with less and more education differed
from country to country.
Differences were greater in the United
Kingdom and Germany than they were
in the US.
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Access to health care
The reasons behind the differences in
mortality from country to country – with
respect to education – are unclear.
The difficulty may arise in initially gaining
access to health care.
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Differences in occupation
Differences in mortality were also found
among different jobs and occupations.
Homemakers, for example, had a 13.5%
1-year mortality compared to 3.5%
among managers.
These results may reflect the educational
level of patients schooled from
1940-1950 (a relatively older cohort).
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Social isolation and mortality
An additional analysis of more than
13 000 patients showed that patients
who live alone have a higher risk profile
upon presentation to the hospital.
The elevated 30-day and 1-year mortality
in this group is due to their risk profile
and is not due to social isolation.
However, social isolation and depression in
tandem may be key factors in
determining prognosis post-MI.
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Additional analyses
Education and mortality results remain
consistent when both smoking status
and gender are controlled.
Patients with a higher level of education
were more likely to quit smoking than
those with less education.
Analyses continue, looking at intervention
strategies and discharge medications in
relation to socioeconomic status and
regional differences.