The influence of health insurance plans on the long term outcome of patients with acute myocardial infarction.
BACKGROUND
Little is known, especially in our country, about the influence of health insurance plans on the long term outcome of patients after acute myocardial infarction (AMI).


OBJECTIVE
To assess the outcome of patients with AMI who are covered by the National Health System (SUS) or other health insurance plans.


METHODS
We analyzed 1,588 patients with AMI (mean age of 63.3 + 12.9 years, 71.7% male) who were included prospectively into a specific database and followed up for up to 7.55 years. Of this total, 1,003 were placed in the "SUS" group and 585 in the "other insurance plans" group. We applied chi-square, log-rank and Cox (stepwise) to the different statistical analyses. The long term multivariate model with mortality as a dependent variable included 18 independent variables.


RESULTS
In-hospital mortality rates in the "other insurance plans" and "SUS" groups were 11.4% and 10.3%, respectively (p = 0.5); in the long term, survival chances in the groups were respectively, 70.4% + 2.9 and 56.4% + 4.0 (p = 0.001, hazard-ratio = 1.43, or a 43% higher chance of death in the "SUS" group). In the adjusted model, the 'SUS' group had a significantly higher chance of death (a 36% higher chance, p = 0.005). Surgical revascularization and angioplasty improved the prognosis of these patients, whereas age and previous history of infarction, diabetes or heart failure worsened the prognosis.


CONCLUSIONS
Relative to patients with other insurance plans, SUS users present similar mortality rates during hospital stay, but their prognosis is worse in the long term, thus reinforcing the need for additional efforts to improve the care provided to these patients after hospital discharge.
Nicolau
José Carlos
JC
Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor HCFMUSP), São Paulo, SP - Brazil. corjnicolau@incor.usp.br
Baracioli
Luciano Moreira
LM
Serrano
Carlos Vicente
CV
Giraldez
Roberto Rocha
RR
Kalil Filho
Roberto
R
Lima
Felipe Galego
FG
Franken
Marcelo
M
Ganem
Fernando
F
Lage
Rony Lopes
RL
Truffa
Rodrigo
R
D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009313:National Health Programs; D010351:Patient Discharge; D011379:Prognosis; D016896:Treatment Outcome