Insurance status and the treatment of myocardial infarction at academic centers.
Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist.


OBJECTIVE
To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers.


METHODS
The Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospective multicenter registry of patients with chest pain presenting to the emergency department who receive an electrocardiogram, was used as the database (N = 17,737). A subset of patients who were diagnosed as having AMI were selected from the database (n = 936). Patients were classified as having either ST-segment elevation MI (n = 178) or non-ST-segment elevation MI (n = 758). Insurance status, age, race, and gender were extracted as predictor variables. The influence of predictor variables on treatment modality was investigated using logistic regression, adjusted for clustering within sites.


RESULTS
The odds of a self-pay patient with ST-segment elevation MI receiving fibrinolytics were 3.23 (95% CI = 1.56 to 6.69) times higher than for other patients. Patients with Medicare coverage were less likely to receive fibrinolytics (odds ratio [OR] 0.35, 95% CI = 0.19 to 0.65) and tended to undergo percutaneous coronary intervention less often (OR 0.60, 95% CI = 0.36 to 1.01). The odds of a privately insured patient's receiving coronary artery bypass grafting (OR 2.76, 95% CI = 1.62 to 4.72) or percutaneous coronary intervention (OR 1.47, 95% CI = 1.03 to 2.11) were higher than for other patients.


CONCLUSIONS
Insurance coverage appears to affect treatment in patients with AMI, with self-pay patients more likely to receive less-expensive therapies and insured patients more likely to receive invasive treatments.
Hiestand
Brian C
BC
Department of Emergency Medicine, The Ohio State University, 149 Means Hall, 1654 Upham Drive, Columbus, OH 43210-1270, USA. hiestand-1@medctr.osu.edu
Prall
Dawn M
DM
Lindsell
Christopher J
CJ
Hoekstra
James W
JW
Pollack
Charles V
CV
Hollander
Judd E
JE
Tiffany
Brian R
BR
Peacock
W Frank
WF
Diercks
Deborah B
DB
Gibler
W Brian
WB
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D017115:Catheter Ablation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy*; D016017:Odds Ratio; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D012846:Singapore; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014481:United States
D019039:Platelet Glycoprotein GPIIb-IIIa Complex