Initial treatment of uninsured patients with ST‐elevation myocardial infarction by facility percutaneous coronary intervention capabilities

Abstract

BackgroundTimely reperfusion is necessary to reduce morbidity and mortality in patients with ST‐elevation myocardial infarction (STEMI). Initial care by facilities with percutaneous coronary intervention (PCI) capabilities reduces time to reperfusion. We sought to examine whether insurance status was associated with initial care at EDs with PCI capabilities amongst adult patients with STEMI.MethodsWe conducted a retrospective cross‐sectional study using Department of Healthcare Access and Information (HCAI), a non‐public statewide database reporting ED visits and hospitalizations in California. We included adults initially arriving at EDs with STEMI by diagnostic code (International Classification of Diseases v9 or 10) from 2011‐2019. Multivariable logistic regression modeling included initial care by PCI capable facility as the primary outcome, and insurance status (none vs. any) as the primary exposure. Covariates included patient, facility, and temporal factors and we conducted multiple robustness checks.ResultsWe analyzed 135,358 eligible visits with STEMI included. In our multivariable model, the odds of uninsured patients being initially treated at a PCI‐capable facility were significantly lower than insured patients (adjusted odds ratio [aOR] 0.62, 95%CI 0.54‐0.72, p<0.001) and was unchanged in sensitivity analyses.ConclusionsUninsured patients with STEMI had significantly lower odds of first receiving care at facilities with PCI capabilities. Our results suggest potential disparities in accessing high‐quality and time‐sensitive treatment for uninsured patients with STEMI.

Interfacility Transfer of Uninsured vs Insured Patients With ST-Segment Elevation Myocardial Infarction in California

“…In preliminary analyses that warrant further investigation, we found that uninsured patients with STEMI were more likely to present to facilities without PCI capabilities. 30 This finding suggests that uninsured individuals may have access to lower resourced facilities (ie, no PCI capabilities). However, for those uninsured patients presenting to lower volume PCI facilities, they have lower odds of staying at the facility compared with patients in facilities with the highest volume quartile (>85 annual PCI procedures).…”