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Poor People, Those on Medicaid Are Much Slower to Arrive at Hospital after Heart Attack
SeniorJournal.Com
September 22, 2008
For some reason it takes poor people suffering heart attack symptoms a lot longer to get to the hospital than others, and this deadly problem has persisted for years. This new study also found that patients with Medicaid were more likely to have a longer delay than were patients with prepaid insurance or with prepaid insurance plus Medicare.
The study, reported in today’s issue of Archives of Internal Medicine, one of the JAMA/Archives journals, examined the medical records of 6,746 men and women hospitalized with acute myocardial infarction (heart attack) between 1993 and 2002.
Patients tend to have better outcomes after a heart attack if they receive medical treatment in a timely manner. This study found, however, those with Medicaid, and those who live in neighborhoods with lower household incomes, are less likely than others to reach the hospital within two hours of having a heart attack.
Time-dependent treatments, such as clot-dissolving therapy or heart catheterization to reopen blocked arteries, are more likely to be given to patients who arrive at the hospital quickly.
“Despite efforts to reduce time elapsed between the onset of acute myocardial infarction symptoms and hospital arrival, prehospital delay times have not improved over the years,” the authors say.
From the records, researchers Randi E. Foraker, M.A., of the University of North Carolina, Chapel Hill, and colleagues determined the prehospital delay time, or the time elapsed between the onset of symptoms and arrival at the hospital.
The addresses of the subjects were linked with 2000 U.S. census socioeconomic data. Median (midpoint) household income for each participant’s area was classified as low (less than $33,533), medium ($33,533 to $50,031) or high ($50,032 or more).
Health insurance status was noted and the distance from the residence to the hospital was calculated.
The arrival time at the hospital for these patients were -
● 36 percent arrived within two hours of developing symptoms (short delay),
● 42 percent between two hours and 12 hours (medium delay) and
● 22 percent between 12 and 72 hours (long delay).
“Low neighborhood household income was associated with a higher odds of long vs. short delay and medium vs. short delay compared with high neighborhood household income in a model including age, sex, race and study community,” the authors write.
“These associations persisted after additionally controlling for health insurance status, diabetes, hypertension, emergency medical services (EMS) use, chest pain, year of acute myocardial infarction event and distance from residence to hospital.”
“Reducing socioeconomic and insurance disparities in prehospital delay is critical because excess delay time may hinder effective care for acute myocardial infarction,” the authors note.
“Prolonged prehospital delay among patients from low neighborhood income areas and among Medicaid recipients suggests a need for increased recognition of and rapid response to acute myocardial infarction symptoms within these populations.
“Interventions that have been considered include the following: community education and awareness campaigns, targeted interventions by health care professionals aimed at reducing prehospital delay among patients with known coronary heart disease and promoting EMS use throughout the community.”
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