Impact of Insurance Status on Clinical Management and Outcomes of Patients with ST-Segment Elevation Myocardial
Sayed Abdulmotaleb Almoosawy1, Abdullah Esmaiel2, Ibrahim Farrag2
1Department of Internal Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
Insights
Insurance status did not impact ST-segment elevation myocardial infarction (STEMI) patient outcomes in Kuwait. Free essential services ensured similar in-hospital and 30-day mortality and adverse events for both insured and noninsured STEMI patients.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Discrepancies in clinical management and outcomes for ST-segment elevation myocardial infarction (STEMI) patients based on health-care insurance type are emerging globally.
- The Kuwait government offers free essential treatments for specific emergency conditions, including to uninsured patients.
- This study investigated potential disparities in STEMI patient care and outcomes related to insurance status within Kuwait.
Purpose of the Study:
- To compare clinical management and in-hospital and 30-day outcomes for STEMI patients with different insurance types in Kuwait.
- To assess the impact of insurance status on acute and short-term adverse cardiac events in STEMI patients.
- To evaluate the effectiveness of government-provided free essential services for uninsured STEMI patients.
Main Methods:
- Data were sourced from the Kuwait Catheterization Laboratory Project (Kuwait CLAP) registry.
- Adult STEMI patients (≥18 years) enrolled between February 2020 and February 2021 were categorized as insured or noninsured.
- Coprimary outcomes included in-hospital and 30-day mortality, with comparisons of adverse cardiac events.
Main Results:
- Out of 668 STEMI patients, 116 (17%) were insured and 552 (83%) were noninsured.
- In-hospital mortality was 2.6% for insured and 1.6% for noninsured; 30-day mortality was 0% for insured and 0.7% for noninsured, with no significant differences (P=0.447 and P=1, respectively).
- Rates of in-hospital complications and 30-day adverse events were similar between insured and noninsured groups.
Conclusions:
- No significant differences in acute or short-term outcomes were observed between STEMI patients with different insurance statuses in Kuwait.
- These findings are reassuring, indicating that free essential services provided by the Kuwait government do not compromise outcomes for uninsured STEMI patients.
- The study supports equitable care delivery for STEMI patients regardless of insurance status in the Kuwaiti healthcare system.
Background:
Emerging evidence from various countries suggests that ST-segment elevation myocardial infarction (STEMI) patients with differing health-care insurance types experience discrepancies in clinical management and outcomes. Kuwait government provides free essential treatments and medications to noninsured patients with certain emergency conditions. We aimed to compare differences in clinical management and in-hospital and 30-day outcomes in STEMI patients with different insurance types in Kuwait.
Methods:
Data were derived from Kuwait Catheterization Laboratory Project (Kuwait CLAP) registry. Adult patients (≥18 years) diagnosed with STEMI were enrolled in Kuwait CLAP registry between February 2020 and February 2021. Patients were categorized into insured and noninsured. The coprimary outcomes were the in-hospital and 30-day mortality in insured versus noninsured patients with STEMI. In-hospital and 30-day adverse cardiac outcomes were also compared.
Results:
Of 668 patients with STEMI, 116 (17%) were insured and 552 (83%) were not insured. Three (2.6%) of the insured and 9 (1.6%) of the noninsured patients suffered in-hospital mortality, while no patients in the insured group and four patients (0.7%) patients in the noninsured group suffered 30-day mortality, with no significant difference between the two groups (P = 0.447 and P = 1, respectively). The rates of in-hospital complications and 30-day adverse events were similar between the two groups.
Conclusions:
Our findings suggest no differences in acute or short-term outcomes among patients with different insurance status in Kuwait. These findings are reassuring knowing that the free essential services provided by Kuwait government for STEMI patients did not compromise the outcomes of noninsured compared to insured patients.
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