Association between the health insurance status and clinical outcomes among patients with acute heart failure in Japan

Fujito, Hidesato; Kitano, Daisuke; Saito, Yuki; Toyama, Kazuto; Fukamachi, Daisuke; Aizawa, Yoshihiro; Miyagawa, Masatsugu; Yoda, Shunichi; Okumura, Yasuo

doi:10.1007/s00380-021-01895-y

Cited by 3 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, the Kaplan–Meier curves for heart failure hospitalization crossed around 6 months, and patients receiving public assistance as compared with those not receiving public assistance were associated with an increased risk for a heart failure hospitalization beyond 180 days. A recent study in Japan showed almost consistent results that AHF patients receiving public assistance had a similar rate of 90 day cardiac events, which were defined as death form cardiovascular disease or heart failure hospitalizations, but had a higher rate of 1 year cardiac events than those not receiving public assistance 18 . That may be at least partly because patients in the public assistance group more frequently had poor medical adherence and were more often living alone.…”

Section: Discussionmentioning

confidence: 77%

“…A recent study in Japan showed almost consistent results that AHF patients receiving public assistance had a similar rate of 90 day cardiac events, which were defined as death form cardiovascular disease or heart failure hospitalizations, but had a higher rate of 1 year cardiac events than those not receiving public assistance. 18 That may be at least partly because patients in the public assistance group more frequently had poor medical adherence and were more often living alone. Moreover, hospitalizations due to social but not medical reasons might have been more common in patients receiving public assistance than those not receiving public assistance.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Public assistance in patients with acute heart failure: a report from the KCHF registry

et al. 2022

View full text Add to dashboard Cite

Aims There is a scarcity of data on the post‐discharge prognosis in acute heart failure (AHF) patients with a low‐income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance. Methods and results The Kyoto Congestive Heart Failure registry was a physician‐initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow‐up of 470 days, the cumulative 1 year incidences of all‐cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all‐cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69–1.32; P = 0.84]. Even after taking into account the competing risk of all‐cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64–1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07–2.29; P = 0.02). Conclusions The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all‐cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238)

show abstract

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Public assistance in patients with acute heart failure: a report from the KCHF registry

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Other studies assessing disparities by indigenous status also highlighted that lack of private health insurance contributed to lower access to angiography and revascularisation procedures, [ 48 , 49 ] including a lower probability of being transferred to metropolitan hospitals for angiography [ 50 ]. Finally, we acknowledge disparities by insurance status may occur in cardiovascular post-discharge care and events [ 9 , 10 , 16 , 17 , 43 ] and further studies should also investigate potential disparities post-discharge.…”

Section: Discussionmentioning

confidence: 99%

“…In countries with highly privatised health systems, AMI inpatients with health insurance, compared with uninsured patients, have higher rates of revascularisation [ 12 ] and better outcomes such as shorter length of stay [ 12 ] and 30%-40% lower rates of in-hospital mortality [ 12 – 14 ], even after adjusting for patient demographic, socioeconomic and clinical characteristics. These differences likely reflect disparities in patient access to surveillance, preventive and hospital care, as well as physician preferences and incentives in performing procedures based on patient insurance status [ 7 , 10 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals

de Oliveira Costa,

Pearson,

Brieger

et al. 2023

Int J Equity Health

View full text Add to dashboard Cite

Background International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods We conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017–2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors. Results Of 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45–0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients. Conclusion Our findings suggest patients undergoing PCI in Australian public hospitals with private health insurance experience lower in-hospital mortality compared with their publicly insured counterparts, but in-hospital complications are not related to patient health insurance status. Our findings are likely due to unmeasured confounding of broader patient selection, socioeconomic differences and pathways of care (e.g. access to emergency and ambulatory care; delays in treatment) that should be investigated to improve equity in health outcomes.

show abstract

Health insurance and clinical outcomes in patients with chronic heart failure in Latin America: an observational study of the Colombian Heart Failure Registry (RECOLFACA)

Plata,

Saldarriaga,

Echeverría

et al. 2024

Heart Vessels

View full text Add to dashboard Cite

Association between the health insurance status and clinical outcomes among patients with acute heart failure in Japan

Cited by 3 publications

References 26 publications

Public assistance in patients with acute heart failure: a report from the KCHF registry

Public assistance in patients with acute heart failure: a report from the KCHF registry

In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals

Health insurance and clinical outcomes in patients with chronic heart failure in Latin America: an observational study of the Colombian Heart Failure Registry (RECOLFACA)

Contact Info

Product

Resources

About