Underuse of invasive procedures among Medicaid patients with acute myocardial infarction

Philbin, Edward F.; McCullough, Peter A.; DiSalvo, Thomas G.; Dec, GW; Jenkins, Paul; Weaver, W. Douglas

doi:10.2105/ajph.91.7.1082

Cited by 34 publications

(7 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both these medical conditions are of course strongly related to presence of diabetes [ 22 ] and indeed were among the strongest independent predictors of DM diagnosis in our study. Other factors independently linking co-existent DM with incident AMI in our multivariable analyses were female sex, non-White race, and comorbid systemic vascular damage have been noted in other studies [ 23 – 26 ].…”

Section: Discussionsupporting

confidence: 52%

Recent US Patterns and Predictors of Prevalent Diabetes among Acute Myocardial Infarction Patients

Ovbiagele

Markovic

Fonarow

2011

Cardiology Research and Practice

View full text Add to dashboard Cite

Background. Diabetes mellitus (DM) confers high vascular risk and is a growing national epidemic. We assessed clinical characteristics and prevalence of diagnosed DM among patients hospitalized with acute myocardial infarction (AMI) in the US over the last decade. Methods. Data were obtained from all states within the US that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 2006 with a primary discharge diagnosis of AMI were included. Time trends in the proportion of these patients with DM diagnosis were computed. Results. The portion of patients with comorbid diabetes among AMI hospitalizations increased substantially from 18% in 1997 to 30% in 2006 (P < .0001). Absolute numbers of AMI hospitalizations in the US decreased 8% (from 729, 412 to 672, 243), while absolute numbers of AMI hospitalizations with coexisting DM rose 51% ((131, 189 to 198, 044), both (P < .0001). Women with AMI were significantly more likely to have DM than similarly aged men, but these differences diminished with increasing age. Conclusion. Although overall hospitalizations for AMI in the US diminished over the last decade, prevalence of diabetes rose substantially. This may have important consequences for the future societal vascular disease burden.

show abstract

Section: Discussionsupporting

confidence: 52%

Recent US Patterns and Predictors of Prevalent Diabetes among Acute Myocardial Infarction Patients

Ovbiagele

Markovic

Fonarow

2011

Cardiology Research and Practice

View full text Add to dashboard Cite

show abstract

“…We selected outcomes previously shown to be influenced by insurance coverage: likelihood of admission to a hospital with PCI capacity ("PCI hospital"), [1] likelihood of transfer for patients who initially presented with AMI to hospitals without PCI capacity, [1,2] likelihood of undergoing PCI during index hospitalization, [9] early PCI defined as having received PCI within 48 hours of admission, [33] in-hospital mortality, and readmission within 30 days of discharge. [6] We defined receipt of PCI by procedure codes in the discharge record (ICD-9 codes 0.66, 17.55, 36.00, 36.04, 36.06, 36.07, 36.09), [25,[34][35][36][37] Following previous literature, we defined hospitals as PCI hospitals if they performed at least 4 PCIs per year. [38][39][40] If a patient was transferred and received PCI at the destination hospital, we considered the procedure to be performed on index hospitalization.…”

Section: Study Outcomesmentioning

confidence: 99%

“…In other words, not all types of insurance may be seen equally; as other studies have found, patients with Medicaid receive different treatment from those with commercial private insurance. [25,46] Ours is the first study that we know of to examine whether the Medicaid expansion affected readmission rates after hospitalization for AMI. The reduction in 30-day readmission rates https://doi.org/10.1371/journal.pone.0232097.g004…”

Section: Plos Onementioning

confidence: 99%

Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction

Valdovinos¹,

Niedzwiecki

Guo

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Introduction Uninsured patients have decreased access to care, lower rates of percutaneous coronary intervention (PCI), and worse outcomes after acute myocardial infarction (AMI). The aim of this study was to determine whether expanding insurance coverage through the Affordable Care Act's expansion of Medicaid eligibility affected access to PCI hospitals, rates of PCI, 30-day readmissions, and in-hospital mortality after AMI. Methods Quasi-experimental, difference-indifferences analysis of Medicaid and uninsured patients with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act, and Florida, which did not, from 2010-2015. This study accounts for the early expansion of Medicaid in certain California counties that began as early as July 2011. Main outcomes included rates of admission to PCI hospitals, rates of transfer for patients who initially presented to non-PCI hospitals, rates of PCI, rates of early PCI defined as within 48 hours of hospital admission, in-hospital mortality, and 30-day readmission. Results 55,991 hospital admissions between 2010-2015 met inclusion criteria. Of these, 32,540 were in California, which expanded Medicaid, and 23,451 were in Florida, which did not. 30day readmission rates after AMI decreased by an absolute difference of 1.22 percentage points after the Medicaid expansion (95% CI-2.14 to-0.30, P < 0.01). This represented a relative decrease in readmission rates of 9.5% after AMI. No relationship between the Medicaid expansion and admission to PCI hospitals, transfer to PCI hospitals, rates of PCI, rates of early PCI, or in-hospital mortality were observed.

show abstract

“…Hospitals that performed 4 or more PCIs per year were considered PCI hospitals [ 5 , 6 , 34 ]. Hospitals performing PCI procedures were identified in the data set using PCI procedure codes in the discharge records (ICD-9 codes 0.66, 17.55, 36.00, 36.04, 36.06, 36.07, 36.09) [ 1 , 12 , 13 , 28 , 35 ]. For a sensitivity analysis examining ST-elevation myocardial infarction (STEMI) patients separately, we identified patients with a primary discharge ICD-9 code of 410.x0, 410.x1, excluding 410.7x and 410.9x, as patients with STEMI.…”

Section: Methodsmentioning

confidence: 99%

The association of Medicaid expansion and racial/ethnic inequities in access, treatment, and outcomes for patients with acute myocardial infarction

Valdovinos¹,

Niedzwiecki

Guo

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Introduction After having an acute myocardial infarction (AMI), racial and ethnic minorities have less access to care, decreased rates of invasive treatments such as percutaneous coronary intervention (PCI), and worse outcomes compared with white patients. The objective of this study was to determine whether the Affordable Care Act’s expansion of Medicaid eligibility was associated with changes in racial disparities in access, treatments, and outcomes after AMI. Methods Quasi-experimental, difference-in-differences-in-differences analysis of non-Hispanic white and minority patients with acute myocardial infarction in California and Florida from 2010–2015, using linear regression models to estimate the difference-in-differences. This population-based sample included all Medicaid and uninsured patients ages 18–64 hospitalized with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act beginning as early as July 2011 in certain counties, and Florida, which did not expand Medicaid. The main outcomes included rates of admission to hospitals capable of performing PCI, rates of transfer for patients who first presented to hospitals that did not perform PCI, rates of PCI during hospitalization and rates of early (within 48 hours of admission) PCI, rates of readmission to the hospital within 30 days, and rates of in-hospital mortality. Results A total of 55,991 hospital admissions met inclusion criteria, 32,540 of which were in California and 23,451 were in Florida. Among patients with AMI who initially presented to a non-PCI hospital, the likelihood of being transferred increased by 12 percentage points (95% CI 2 to 21) for minority patients relative to white patients after the Medicaid expansion. The likelihood of undergoing PCI increased by 3 percentage points (95% CI 0 to 5) for minority patients relative to white patients after the Medicaid expansion. We did not find an association between the Medicaid expansion and racial disparities in overall likelihood of admission to a PCI hospital, hospital readmissions, or in-hospital mortality. Conclusions The Medicaid expansion was associated with a decrease in racial disparities in transfers and rates of PCI after AMI. We did not find an association between the Medicaid expansion and admission to a PCI hospital, readmissions, and in-hospital mortality. Additional factors outside of insurance coverage likely continue to contribute to disparities in outcomes after AMI. These findings are crucial for policy makers seeking to reduce racial disparities in access, treatment and outcomes in AMI.

show abstract

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction

Cited by 34 publications

References 46 publications

Recent US Patterns and Predictors of Prevalent Diabetes among Acute Myocardial Infarction Patients

Recent US Patterns and Predictors of Prevalent Diabetes among Acute Myocardial Infarction Patients

Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction

The association of Medicaid expansion and racial/ethnic inequities in access, treatment, and outcomes for patients with acute myocardial infarction

Contact Info

Product

Resources

About