{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T08:52:26Z","timestamp":1772009546086,"version":"3.50.1"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>There are limited data on uninsured patients presenting with acute myocardial infarction-cardiogenic shock (AMI-CS). This study sought to compare the management and outcomes of AMI-CS between uninsured and privately insured individuals.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Using the National Inpatient Sample (2000\u20132016), a retrospective cohort of adult (\u226518 years) uninsured admissions (primary payer\u2014self-pay or no charge) were compared with privately insured individuals. Interhospital transfers were excluded. Outcomes of interest included in-hospital mortality, temporal trends in admissions, use of cardiac procedures, do-not-resuscitate status, palliative care referrals, and resource utilization.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Of 402\u2009182 AMI-CS admissions, 21\u2009966 (5.4%) and 93\u2009814 (23.3%) were uninsured and privately insured. Compared with private insured individuals, uninsured admissions were younger, male, from a lower socioeconomic status, had lower comorbidity, higher rates of acute organ failure, ST-segment elevation AMI-CS (77.3% versus 76.4%), and concomitant cardiac arrest (33.8% versus 31.9%; all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Compared with 2000, in 2016, there were more uninsured (adjusted odds ratio, 1.15 [95% CI, 1.13\u20131.17];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and less privately insured admissions (adjusted odds ratio, 0.85 [95% CI, 0.83\u20130.87];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Uninsured individuals received less frequent coronary angiography (79.5% versus 81.0%), percutaneous coronary intervention (60.8% versus 62.2%), mechanical circulatory support (54% versus 55.5%), and had higher palliative care (3.8% versus 3.2%) and do-not-resuscitate status use (4.4% versus 3.2%; all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Uninsured admissions had higher in-hospital mortality (adjusted odds ratio, 1.62 [95% CI, 1.55\u20131.68];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and resource utilization.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Uninsured individuals have higher in-hospital mortality and lower use of guideline-directed therapies in AMI-CS compared with privately insured individuals.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.121.008991","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T10:00:12Z","timestamp":1646388012000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Management and Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Uninsured Compared With Privately Insured Individuals"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1631-8238","authenticated-orcid":true,"given":"Saraschandra","family":"Vallabhajosyula","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1899-0386","authenticated-orcid":true,"given":"Vinayak","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (V.K., B.J.G., A.L., A.S.J., D.R.H., M.R.B., G.W.B.), Mayo Clinic, Rochester, MN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pranathi R.","family":"Sundaragiri","sequence":"additional","affiliation":[{"name":"Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, NC (P.R.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9954-9711","authenticated-orcid":true,"given":"Wisit","family":"Cheungpasitporn","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine (W.C.), Mayo Clinic, Rochester, MN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0595-1492","authenticated-orcid":true,"given":"P. Elliott","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT (P.E.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7952-0217","authenticated-orcid":true,"given":"Sri","family":"Harsha Patlolla","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery (S.H.P.), Mayo Clinic, Rochester, MN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5605-900X","authenticated-orcid":true,"given":"Bernard J.","family":"Gersh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (V.K., B.J.G., A.L., A.S.J., D.R.H., M.R.B., G.W.B.), Mayo Clinic, Rochester, MN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-5313","authenticated-orcid":true,"given":"Amir","family":"Lerman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (V.K., B.J.G., A.L., A.S.J., D.R.H., M.R.B., G.W.B.), Mayo Clinic, Rochester, MN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1183-3959","authenticated-orcid":true,"given":"Allan S.","family":"Jaffe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (V.K., B.J.G., A.L., A.S.J., D.R.H., M.R.B., G.W.B.), Mayo Clinic, Rochester, MN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilay D.","family":"Shah","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. 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