Poor People, Those on Medicaid are Much Slower to
Arrive at Hospital after Heart Attack
Researchers say this deadly problem has persisted
unchanged for years
Sept. 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.”
Editor's Note:
This research was supported by a contract from the
National Heart, Lung, and Blood Institute and was also funded in part by
a National Institutes of Health, NHLBI and National Research Service
Award training grant. The Atherosclerosis Risk in Communities (ARIC)
study is carried out as a collaborative study supported by NHBLI
contracts.
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Sept. 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. 