Associations Between Education Level and In-hospital Treatment and Outcomes Among Acute Coronary Syndrome in China

Background: Previous studies have shown an inverse relationship between education and clinical outcomes in coronary heart disease. Whether a similar association exists in patients presenting with suspected acute coronary syndromes (ACS) in China is unknown.

Methods: Clinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a study to evaluate a quality improvement for ACS management in China which implemented in 75 hospitals between October 2007 and August 2010. All patients was divided into 6 groups by education level. We evaluated clinical managements and outcomes according to level of education.

Results: A total of 14350 patients were enrolled in current analysis. Patients with less education were older, had greater female representation and had a higher Killip class at admission. Compared to patients with lower education levels, more educated patients had a longer length of hospitalization (p for trend <0.001), greater likelihood of receiving appropriate coronary angiography (p for trend <0.001) and appropriate reperfusion therapy for ST-segment elevated myocardial infarction (STEMI) (p for trend <0.001) even after adjustment for differences in patient characteristics and comorbidities at presentation. Patients with less education were at higher risk of death, cardiac death and major adverse cardiovascular events but none of these differences remained statistically significant after adjustment for baseline characteristics.

Conclusion: In China, less educated patients with ACS were less likely to receive appropriate coronary angiography and reperfusion therapy. Less educated patients were at higher risk for adverse clinical events; however this was explained by differences in baseline characteristics.