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Journal of the American College of Cardiology

Clinical Articles, News & Views

Lower income increases risk of death after cardiac surgery

Low household income is associated with higher risk of death after cardiac surgery, even in countries where the entire population has access to free healthcare, according to a study published recently in the Journal of the American College of Cardiology.1

Researchers in this study looked at patients in Sweden who had cardiac surgery over a 14-year span. All patients had access to the same healthcare plan and hospital quality under the country’s universal system. All cardiac surgeries in Sweden are performed at a small number of centres with similar standards of care and performance.

According to the researchers, the association between low income and death remained the same despite other socioeconomic status variables, comorbidities and cardiovascular risk factors. The study shows that the impact of socioeconomic status on death cannot be explained by disparities in healthcare alone, and ways to better implement secondary prevention measures for low-income patients should be explored.

Limitations of the study include that registry data used did not include information on lifestyle factors such as smoking habits, job strain, diet, level of physical activity and compliance with medication, the authors make clear. There were also no data on medication or healthcare during the follow-up period.


1. Dalén M, Ivert T, Holzmann MJ, Sartipy U. Household disposable income and long-term survival after cardiac surgery: a Swedish Nationwide Cohort Study in 100,534 patients. Journal of the American College of Cardiology 2015;66:1888–97.

Published on: October 30, 2015

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