19. Disparities in health care delivery and hospital outcomes between expatriates and nationals presenting with acute coronary syndromes in Saudi Arabia

Abstract

Saudi Arabia has a large expatriate population. We explored the difference and similarities between Non-Saudi patients (NS) presenting with an acute coronary syndrome and Saudi nationals (SN) with respect to therapies and clinical outcomes. Methods: ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) from 2005 to 2007 are the subjects of this analysis. 5055 patients were enrolled in SPACE. Propensity score matching and logistic regression analysis were performed to account for major imbalances in age and gender. Results: 2031 ACS patients were available for analysis. The mean age was 56.2 ± 9.8, and males formed 83.5% of the study cohort. SN were more likely to have risk factors of atherosclerosis. ST-elevation MI (STEMI) was the most common ACS presentation in NS, while Non-ST ACS was more common in SN. The median symptom to door time was significantly longer in NS patients (175 min (197) vs. 130 min (167), p = 0.027). There were no differences in pharmacological therapies between the two groups, Except that NS were more likely to receive fibrinolytic therapy. NS were less likely to undergo percutaneous coronary interventions (PCI), or primary PCI compared to Saudis (32.6% vs. 42.8%, p = 0.0001, and 7.8% vs. 22.8%, p < 0.001, respectively). Hospital mortality, cardiogenic shock, and Heart failure were significantly higher in NS compared to SN. After adjusting for baseline variables, and therapies, the odds ratio for hospital mortality, and Cardiogenic shock in NS were 2.9 (95% CI 1.5–6.2, p = 0.004), and 2.8 (1.5–4.9), p < 0.001, respectively. Conclusion: Our findings indicate disparities in hospital care between NS, and SN ACS patients. NS patients had worse hospital outcomes potentially reflecting unequal health coverage, and access to care issues.