Abstract P346: Socioeconomic Status and Patterns of Follow-up Care after Myocardial Infarction the Atherosclerosis Risk in Communities (ARIC) Study
Background Presence of an outpatient (OP) visit within 2 weeks of discharge and visits with the same provider both during hospitalization and during OP follow-up have been shown to improve outcomes following myocardial infarction (MI). Morbidity and mortality post MI are high among those with low socioeconomic status (SES). Therefore, the goal of this study was to describe post-MI continuity of care according to selected SES factors.
Methods Study participants included members of the ARIC Study cohort who survived an index MI hospitalization between 1/1/2000 and 12/31/2007 with continuous Part A and Part B Medicare fee-for-service coverage for at least 2 years following discharge or until death. Persons without a edicare hospitalization claim corresponding to the MI ascertained during ARIC cohort surveillance were excluded. We identified 328 ARIC participants that met study criteria. Time from inpatient to outpatient care was summarized by income, high school graduation status (HS), and Medicaid coverage at time of MI. Income and HS were assessed at ARIC baseline visit (1987). Medicaid coverage was determined from State-Buyin codes obtained from Medicare enrollment files for the month of MI occurrence. Time to first OP visit was analyzed using Kaplan-Meier methods to account for censoring at first all-cause hospital readmission.
Results Proportions of subjects (57%, 26%, 18%) with low SES (not a high school graduate, Income <$16K, Medicaid Coverage) that have their first OP visit within 2 weeks were lower than the proportion of subjects (65%, 46%, 42%) with high SES (HS graduate, Income >=$16K, No Medicaid Coverage). Those with Medicaid coverage at time of MI or low baseline income had median time to first OP visit of 21 or 19 days respectively (Figure 1). The number of OP visits after 1 year was different (p<0.05) by education and income but the percent of visits to a cardiologist within 1 year did not differ by SES (overall mean 22%).
Conclusion Low socioeconomic status is associated with worse continuity of care following MI.
- © 2013 by American Heart Association, Inc.