Department of Cardiology, Tokyo Yamate Medical Center, Tokyo, Japan.
Department of Cardiology, Tokyo Yamate Medical Center, Tokyo, Japan.
J Cardiol. 2021 Apr;77(4):404-407. doi: 10.1016/j.jjcc.2020.10.013. Epub 2020 Nov 9.
An increase in the rate of relative poverty and the number of welfare recipients is a serious social problem in Japan. A recent overseas survey demonstrated that lack of health insurance was associated with increased in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study is to investigate the clinical features of STEMI patients who receive welfare public assistance in Japan.
We enrolled 525 STEMI patients who were hospitalized in our hospital from 2010 to 2019. We divided patients into groups of patients receiving welfare public assistance (WPA group, N = 67) and groups of patients not receiving welfare public assistance (non-WPA group, N = 458). Patient characteristics, clinical outcome, and cardiac function on transthoracic echocardiography were compared.
WPA group were younger than non-WPA group (61.2 ± 10.9 years VS 64.5 ± 13.3 years, p = 0.03). The prevalence of smoking was higher in WPA group compared to non-WPA group (91.0% VS 81.1% p = 0.04) and high-density lipoprotein cholesterol value of WPA group was lower than in non-WPA group (43.2 ± 9.9 mg/dl vs 47.1 ± 12.8 mg/dl, p = 0.005). Ventricular arrhythmia on admission was significantly more frequent in WPA group (11.9% VS 4.8%, p = 0.02). In acute and chronic phase, left ventricular ejection fraction in WPA group was lower than non-WPA group (in acute phase 46.6 ± 10.7% vs 53.3 ± 8.6% p = 0.001, in chronic phase 48.7 ± 10.1% vs 55.3 ± 9.4%, p = 0.008).
STEMI patients receiving welfare public assistance had poorer control of coronary risk, increased risk of fatal arrhythmia, and reduced systolic function than those not receiving welfare public assistance. It is necessary to have a system that can strengthen lifestyle management, such as diet and smoking cessation for the purpose of improving the prognosis of welfare recipients after AMI.
在日本，相对贫困率和福利领取人数的增加是一个严重的社会问题。最近的一项海外调查表明，缺乏健康保险与 ST 段抬高型心肌梗死（STEMI）患者住院死亡率的增加有关。本研究旨在调查日本接受福利公共援助的 STEMI 患者的临床特征。
我们纳入了 2010 年至 2019 年在我院住院的 525 例 STEMI 患者。我们将患者分为接受福利公共援助的患者组（WPA 组，N=67）和不接受福利公共援助的患者组（非 WPA 组，N=458）。比较患者特征、临床结局和经胸超声心动图的心脏功能。
WPA 组患者比非 WPA 组年轻（61.2±10.9 岁比 64.5±13.3 岁，p=0.03）。WPA 组的吸烟率高于非 WPA 组（91.0%比 81.1%，p=0.04），WPA 组的高密度脂蛋白胆固醇值低于非 WPA 组（43.2±9.9mg/dl 比 47.1±12.8mg/dl，p=0.005）。入院时 WPA 组室性心律失常的发生率明显高于非 WPA 组（11.9%比 4.8%，p=0.02）。在急性期和慢性期，WPA 组的左心室射血分数均低于非 WPA 组（急性期 46.6±10.7%比 53.3±8.6%，p=0.001，慢性期 48.7±10.1%比 55.3±9.4%，p=0.008）。
与未接受福利公共援助的患者相比，接受福利公共援助的 STEMI 患者的冠状动脉风险控制较差，致命性心律失常风险增加，收缩功能降低。有必要建立一个系统，为福利接受者提供饮食和戒烟等生活方式管理方面的强化措施，以改善 AMI 后福利接受者的预后。
