Low-income heart attack sufferers are more likely to die.

According to new research, if you're poor and experience a severe form of heart attack, your chances of surviving it are much lower than if you're wealthy.

According to senior researcher Dr. Abdul Mannan Khan Minhas, a hospitalist at the Hattiesburg Clinic Hospital Care Service in Mississippi, the finding highlights the need to close a healthcare gap that disproportionately affects low-income patients. "A lot of work is being done in this area," he said, "but obviously, as several studies have demonstrated, a lot more has to be done."

An ST-elevation myocardial infarction, popularly known as STEMI, is the type of heart attack researched by his team. STEMI is more severe and dangerous than other types of heart attacks because it affects the bottom chambers of the heart.

The researchers looked at a database of adults diagnosed with STEMI in the United States between 2016 and 2018, sorting patients by ZIP code to determine household income. They also developed methods for comparing patient outcomes. There were 639,300 STEMI hospitalizations in total, with around 35% of patients falling into the lowest economic bracket. Around 19 percent were in the highest income bracket.

According to the study, the poorest patients had the greatest death rate from all causes, at 11.8 percent, compared to 10.4 percent for those in the highest income group. They also had more intrusive mechanical ventilation and lengthier hospital stays. The amount of money spent on their treatment, however, was lower — $26,503 against $30,540 for the top-income group, according to the study.

Poor patients lived over two years longer than their wealthy counterparts, while being more likely to die (63.5 years versus 65.7).They were also more likely to be Black, Hispanic, or Native American women. They had multiple diseases or conditions, which was the most critical factor.

"They were already sicker," Minhas explained. "In comparison to the other group of patients, these individuals had greater chronic lung disease, [high blood pressure], diabetes, heart failure, alcohol/drug/tobacco misuse, and a history of previous stroke. That is most likely the most crucial element they believe is leading to the discrepancy."At the same time, people with lower incomes were less likely to obtain health insurance.

Social variables have been found to have a significant impact on disease outcomes in previous research. According to the US Department of Health and Human Services, social determinants of health include "the conditions in the surroundings where people are born, live, learn, work, play, worship, and age." They can include things like access to safe housing, racism, work opportunities, healthy food access, air quality, and income.

Lower socioeconomic status has been connected to poorer clinical results in heart disease patients, as well as having other health problems.The data were examined by Dr. Triston Smith, medical director of the cardiovascular program at Trinity Health System in Steubenville, Ohio.

"My first thought is that it's a stunning indictment of our healthcare system," he said. "These discrepancies exist and make life and death situations simply dependent on one's income and ZIP code." "I think there's a lot to dissect here, but on the surface, this doesn't look good for the way we treat heart attack victims."

Smith believes that a number of variables contribute to these findings. Poor patients, for example, are disadvantaged throughout their lives due to co-existing illnesses, he noted.Even if people in both groups have the same medical conditions, such as diabetes, those in the poorer group may not be able to afford the prescriptions needed to manage the disease, according to Smith.

"The other thing I found here that was quite disturbing to me was the cost of care," Smith said. Despite the fact that the poorest patients died at a higher rate, less money was spent on their care.

"This is a conundrum that we need to investigate because are we jeopardizing the care of patients from lower socioeconomic categories by providing them with ineffective therapies?" Smith explained.

The findings were presented at a meeting of the Society of Cardiovascular Angiography and Interventions in Atlanta on Wednesday. The Society for Cardiovascular Angiography and Interventions has already published an abstract in its journal.

Meeting findings are considered preliminary until they have been published in a peer-reviewed journal.To remedy the problem, study author Minhas says policy and public health actions are required."They should be directed to alleviate these gaps, with targeted public health interventions addressing socioeconomic disparities," he said.

Furthermore, research should look into these disparities in access to care."We need more prospective population-based research and more robust study designs to help us probe and study the effects of social economic disparities on cardiovascular outcomes, such as income and education, among other things," Minhas added.

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