Abstract 179: The correlation between Insurance Coverage and Long-term Outcomes in patients presenting with ACS: An ACAP-PAIN Registry Analysis
BACKGROUND: To look for the association between Insurance coverage (IC) and Long term Outcomes (O) after discharge following ACS admission from ACAP-PAIN (AP) registry. METHODS: The AP registry had 5526 hospitalized patients admitted with a diagnosis of ACS enrolled between 2006-2010. Long-term outcomes (composite of death, AMI, and ACS readmission) were evaluated during a Follow-up period of 4 yrs. Patients were stratified into 5 medical insurance groups: Government (Gov) (n = 2571), Managed Government (MGov) (n = 1229), HMO (n = 630), Commercial (Com) (n = 863), and other (O) (n = 233). RESULTS: Composite endpoint at the end of the follow up was seen in 29%, 23%, 16%, 15%, and 12%, (p <0.0001), and all-cause mortality was seen in 6.5%, 6.2%, 3.9%, 3.1%, and 1.2%, (p<0.001), of the 5 medical insurance groups, respectively. Patients with Gov and MGov care coverage were older, with higher incidence of CAD, hypertension and diabetes. After adjusting for confounding variables, the multivariable-adjusted odds for composite endpoint was 1.73 (95% confidence interval [CI], 0.56-1.36) for Gov patients, 1.07 (95% CI, 0.93-1.24) for MGov patients, 0.56 (95% CI, 0.45-0.70) for HMO patients, 0.55 (95% CI, 0.46-0.67) for Com patients, and, 0.42 (95% CI, 0.29-0.63) for O patients. (See Graph) CONCLUSIONS: The results of this population-based study demonstrate that ACS patients with any government insurance status have an increased long term morbidity and mortality. This may be explained at least partially by the patients’ characteristics.