Impact of Socioeconomic Status on Major Adverse Cardiac Events After Coronary Angioplasty

Nabeel Tariq; Syed Nasir Ali Shah; Liaquat Ali; Shahid Amin; Moiz Naeem Butt; Moid Khan; Quratulain; Sana Ullah Kakar

doi:10.70749/ijbr.v3i3.775

Authors

Nabeel Tariq Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Syed Nasir Ali Shah Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Liaquat Ali Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Shahid Amin Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Moiz Naeem Butt Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Moid Khan Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Quratulain Balochistan Institute of Psychiatry and Behavioral Sciences (BIPBS), Quetta, Balochistan, Pakistan.
Sana Ullah Kakar Balochistan Institute of Psychiatry and Behavioral Sciences (BIPBS), Quetta, Balochistan, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i3.775

Keywords:

Socioeconomic Status, Major Adverse Cardiac Events, Percutaneous Coronary Intervention, Healthcare Disparities, Medication Adherence, Psychological Stress, Cardiovascular Outcomes

Abstract

Background: Although socioeconomic status (SES) is a well-established predictor of health outcomes, less is known about how it affects major adverse cardiac events (MACE) following percutaneous coronary intervention (PCI), especially in poor countries. Methods: Between January and December 2024, 250 patients who received PCI at a tertiary care hospital, Quetta participated in a prospective qualitative study. Based on their occupation, income, and level of education, patients were divided into three SES groups: low, middle, and high. Semi-structured interviews, focus groups, and medical record analysis were used to gather data. Key patterns in patient experiences and healthcare access were evaluated using thematic analysis. Results: Low-SES patients had the highest incidence of MACE (52%) compared to middle- and high-SES patients (31% and 20%, respectively. 70% of the low-SES group reported irregular medication use, and 60% missed follow-up sessions, indicating significantly worse medication adherence and follow-up compliance. Low-SES patients also had higher rates of psychological stress and impediments to accessing healthcare (78% and 65%, respectively). Furthermore, compared to 72% of middle-class patients and 90% of high-class patients, only 38% of low-SES patients expressed satisfaction with their post-PCI care. Conclusion: Poorer post-PCI outcomes, such as increased incidence of MACE, decreased medication adherence, and increased psychosocial stress, are linked to lower SES. To improve long-term cardiovascular health in socioeconomically disadvantaged groups, addressing these inequities calls for a multimodal strategy that includes improved healthcare accessibility, focused education activities, and financial support programs.

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