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Heart Attack Care Substandard in Medicaid Patients

Study finds that insurance status is associated with disparities in level of care and mortality rates

FRIDAY, Nov. 24 (HealthDay News) -- Among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), those on Medicaid receive lower-quality care and experience worse outcomes than those with HMOs or private insurance, according to study findings published in the Nov. 21 issue of the Annals of Internal Medicine.

James Calvin, M.D., of the Rush University Medical Center in Chicago, and colleagues assessed data on 37,345 NSTE ACS patients under age 65, including those on Medicaid, and 59,550 patients over age 65, including those on Medicare.

The researchers found that Medicaid patients were less likely than patients with HMOs or private insurance to receive aspirin, beta-blockers, clopidogrel, lipid-lowering agents, dietary counseling, smoking cessation counseling and referral for cardiac rehabilitation before discharge. They also found that Medicaid patients were more likely to experience delays in acute care. In patients under age 65, the unadjusted in-hospital mortality rates were significantly higher in Medicaid patients (2.9 percent versus 1.2 percent) while in patients over age 65, the rates for Medicare patients and those with HMOs or private insurance were not significantly different (6.2 percent versus 5.6 percent).

"Because improved use of evidence-based therapies for patients with NSTE ACS is associated with lower mortality rates, further investigation is needed to understand the root causes for these findings and to determine novel strategies to ameliorate health care disparities and reduce mortality rates for Medicaid patients," the authors conclude.

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