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This study examines how educational levels impact the quality and outcomes of health care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cohort of ACS patients hospitalized in five Swiss university hospitals was categorized into four educational levels (EL) with EL1 defined as lower than vocational school and EL4 as a university degree. The use of medical therapies, achievement of preventive targets and risk of clinical events were evaluated across ELs at baseline (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20096040), 1\u2010year (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20095756) and 5\u2010years (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20092253) and presented with adjusted marginal odds ratios (mOR), average marginal effect (AME) and hazard ratios (HRs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 6040 patients, the mean age was 63\u2009years, and 81% were male. Participants with lower EL had a greater burden of cardiovascular risk factors at baseline. Compared with EL4 participants EL1 participants had lower adherence to cardiac rehabilitation (mOR\u2009=\u2009.6 [95% CI .5\u2013.8], AME\u2009=\u2009\u221210%) and were less likely to be followed by a cardiologist (mOR .6 [95% CI .5\u2013.8], AME\u2009=\u2009\u22126%). Use of medical therapies did neither differ across EL at discharge nor during follow\u2010up. At 1 year, smoking cessation (mOR\u2009=\u2009.7 [95% CI .5\u2013.9], AME\u2009=\u2009\u221210%) and weight reduction \u22655% among overweight or obese participants (mOR\u2009=\u2009.7 [95% CI .5\u2013.9], AME\u2009=\u2009\u22126%) were less frequent in individuals with EL1 compared with EL4. At long term, achievement of LDL\u2010C &lt;1.8\u2009mmol\/L (&lt;70\u2009mg\/dL) (mOR\u2009=\u2009.6 [95% CI .4\u2013.9], AME\u2009=\u2009\u22129%) was less frequent in individuals with EL1 compared with EL4. Lower EL was associated with an increased risk of major acute coronary event (MACE) at short\u2010 (aHR\u2009=\u20091.4 [95% CI 1.0\u20132.0] for EL1 vs. EL4) and long term (aHR\u2009=\u20091.3 [95% CI 1.0\u20131.6] for EL1 vs. EL4) and all\u2010cause death at long term (aHR\u2009=\u20091.6 [95% CI 1.1\u20132.2] for EL1 vs. EL4).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Switzerland, disparities in ACS care and outcomes remain across EL, emphasising the need for tailored interventions to reduce inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/eci.70097","type":"journal-article","created":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T08:24:47Z","timestamp":1753518287000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Educational level, clinical outcomes and quality of care in a Swiss cohort of patients with acute coronary syndromes"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8387-1693","authenticated-orcid":false,"given":"Ma\u00eblle","family":"Achard","sequence":"first","affiliation":[{"name":"Cardiology Department Geneva University Hospitals  Geneva Switzerland"},{"name":"Institute of Global Health University of Geneva  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9dric","family":"Follonier","sequence":"additional","affiliation":[{"name":"Cardiology Department Geneva University Hospitals  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evelyne","family":"Fournier","sequence":"additional","affiliation":[{"name":"Institute of Global Health University of Geneva  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Carballo","sequence":"additional","affiliation":[{"name":"Cardiology Department Geneva University Hospitals  Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Branca","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine, and Clinical Trials Unit, Department of Clinical Research University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dik","family":"Heg","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine, and Clinical Trials Unit, Department of Clinical Research University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Nanchen","sequence":"additional","affiliation":[{"name":"Department of Ambulatory Care and Community Medicine Lausanne University  Lausanne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenz","family":"R\u00e4ber","sequence":"additional","affiliation":[{"name":"Department 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