Lower Financial Status and Adherence to Medication Determines 10-Year (2004-2014) All-Cause Mortality and Risk for Acute Coronary Syndrome Incidence Among Cardiac Patients: the GREECS Study

Background: Financial status has been considered as an important health determinant and associated with compliance to healthier lifestyle habits, medical treatment and increased prevalence of mental disorders. The aim of this work was to evaluate the association between financial status, patient adherence to medication, 10-year allcause mortality and risk for Acute Coronary Syndrome (ACS), in a Greek sample of cardiac patients. Methods: From October 2003-September 2004 a sample of 2,172 consecutive ACS patients from 6 hospitals was enrolled. In 2013-14, the 10-year follow-up was performed in 1,918 participants. Adherence to medical treatment was recorded through self-reports and financial status was classified as low (<9,000), moderate (9-18,000), good (19-48,000) and very good (>48,000). Results: The “low”-to-“very” good financial status 10-year all-cause mortality rate was 1.7:1 (p<0.001). Unadjusted analysis revealed no association between financial status and ACS incidence (p=0.22); however, multi-adjusted analysis, after taking into account various clinical and lifestyle factors, revealed that “good/very good” financial status was associated with 23% (95%CI 2%, 40%, p=0.04) lower 10-year risk of ACS as compared with “low/moderate”; a finding that became insignificant when adherence to medication was taken into account. Conclusions: Low financial status seems to play a critical role in the long-term ACS prognosis. Health policies, to tackle non-compliance to medication, are needed to minimize the disease burden in clinical and community settings.