Information about uninsured patients with acute myocardial infarction-cardiogenic shock (AMI-CS) was limited. Therefore, making comparisons regarding the management and results of AMI-CS between uninsured and privately insured patients was the main objective of this study. A backdated cohort of adults, 18 years old or over, uninsured admissions (primary payer—self-pay or no charge) were matched with privately insured individuals. The researchers utilized the National Inpatient Sample (2000-2016). They also excluded interhospital transfers from this. Results of interest comprised temporal trends in admissions, in-hospital mortality, do-not-resuscitate status, the usage of cardiac procedures, resource utilization, and palliative care referrals.

About 21,966 (5.4%) and 93,814 (23.3%) out of the 4,02,182 AMI-CS admissions were uninsured and privately insured, respectively. Uninsured admissions were male, from a lower socioeconomic status, younger, had higher rates of acute organ failure, had lower comorbidity, concomitant cardiac arrest (33.8% versus 31.9%; all P<0.001), and ST-segment elevation AMI-CS (77.3% versus 76.4%) in comparison to privately insured individuals. Admissions of privately insured patients were lesser (adjusted odds ratio, 0.85 [95% CI, 0.83–0.87]; P<0.001) and uninsured patients were higher (adjusted odds ratio, 1.15 [95% CI, 1.13–1.17]; P<0.001) in 2016 in comparison to 2000. Individuals who were uninsured had less frequent coronary angiography (79.5% versus 81.0%), mechanical circulatory support (54% versus 55.5%), percutaneous coronary intervention (60.8% versus 62.2%), and had greater do-not-resuscitate status use (4.4% versus 3.2%; all P<0.001) and palliative care (3.8% versus 3.2%). There was higher in-hospital mortality (adjusted odds ratio, 1.62 [95% CI, 1.55–1.68]; P<0.001) and resource usage for uninsured admissions.

In comparison to privately insured individuals, the in-hospital mortality was more significant, and the usage of guideline-directed therapies in AMI-CS was lower for uninsured individuals. 

 

Link:www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.008991