Influence of primary payer status on non-ST segment elevation myocardial infarction: national retrospective 18-year cohort time trends, management and outcomes

This article was originally published here

Ann Transl Med. 2021; 9 (13): 1075. doi: 10.21037 / atm-20-5193.


BACKGROUND: The role of insurance on outcome in patients with non-ST segment elevation myocardial infarction (NSTEMI) is limited to contemporary times.

METHODS: From the national inpatient sample, adult NSTEMI admissions were identified [2000-2017]. The expected primary payer has been categorized as Medicare, Medicaid, Private, Uninsured, and Others. Results included in-hospital mortality, global and early coronary angiography, percutaneous coronary intervention (PCI), resource use, and readiness to discharge.

RESULTS: Of the 7,290,565 NSTEMI admissions, Medicare, Medicaid, private, uninsured and other insurance were rated in 62.9%, 6.1%, 24.1%, 4.6% and 2.3% , respectively. Compared to others, those with health insurance older (76 vs. 53-60 years old), more likely to be female (48% vs. 25-44%), Caucasian, and with higher comorbidity (all P vs. 65-74%; early 15% vs. 22-27%) and PCI (27% vs. 35-44%) were used less in the Medicare population. The Medicare population had longer lengths of stay, lower hospital costs, and fewer home discharges.

CONCLUSIONS: Compared to other types of primary payers, NSTEMI admissions with Medicare insurance had lower use of coronary angiography and PCI, and higher hospital mortality.

PMID: 34422987 | PMC: PMC8339860 | DOI: 10.21037 / atm-20-5193

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