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The influence of health insurance plans on the long term outcome of patients with acute myocardial infarction.

Abstract：

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.

journal_name

Arq Bras Cardiol

journal_title

Arquivos brasileiros de cardiologia

authors

Nicolau JC,Baracioli LM,Serrano CV Jr,Giraldez RR,Kalil Filho R,Lima FG,Franken M,Ganem F,Lage RL,Truffa R

doi

10.1590/s0066-782x2008001800004

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

347-51

issue

6

eissn

0066-782X

issn

1678-4170

pii

S0066-782X2008001800004

journal_volume

91

pub_type

杂志文章

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