Impact of Insurance Status on Clinical Management and Outcomes of Patients with ST-Segment Elevation Myocardial Infarction: Findings from the Kuwait Catheterization Laboratory Project Registry

Abstract

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.