Abstract 12266: Treatment and Outcomes of Dual Medicare/Medicaid Eligible Older Adults With Myocardial Infarction

Abstract

Introduction: Patients with dual Medicare-Medicaid eligibility typically have higher burden of chronic disease conditions and increased healthcare utilization than patients with Medicare coverage alone. For patients with acute MI, in-hospital treatment patterns and longitudinal outcomes of dual eligible patients are unknown. Methods: We linked MI patients 65 years or older in the ACTION Registry-GWTG from 2007 to 2009 to Medicare claims data. We used multivariable Cox regression to compare risks of all-cause readmission by 30 days and major adverse cardiovascular events (MACE: death, MI, stroke) by 1 year between dual eligible vs. Medicare-only patients. Results: Of 17,419 Medicare patients discharged after MI, 4,674 (27%) were dual eligible. Dual eligible patients were more likely to be female (64% vs. 49%) and non-white (29% vs. 6%), to have a greater prevalence of comorbid conditions (mean Charlson comorbidity index 3.7 vs. 3.0) and to present with non-STEMI (75% vs. 69%). Rates of reperfusion for STEMI (91 vs 93%, p=0.006) and revascularization for NSTEMI (58% vs. 65%, p<0.001) were significantly lower for dual eligible compared with Medicare only patients in the absence of contraindications. Unadjusted rates of 30-day all-cause readmission and 1-year MACE were higher among dual eligible patients (Figure). After adjustment for differences in patient characteristics and in-hospital treatment, dual eligible status remained associated with higher risk of 30-day readmission (HR 1.16, 95% C.I. 1.06-1.26) and 1-year MACE (HR 1.21; 95% C.I. 1.12-1.31). Conclusions: Patients with dual Medicare/Medicaid eligibility were less likely receive reperfusion or revascularization during the index MI hospitalization and had worse short- and long-term outcomes than patients with Medicare coverage alone. Despite the additional support provided by Medicaid coverage, this is a vulnerable population that will benefit from interventions to optimize post-MI outcomes.