Department of Cardiology, DIME Clínica Neurocardiovascular, Cali, Colombia.
Department of Cardiology, Clínica Cardio VID, Medellín, Colombia.
Heart Vessels. 2024 Dec;39(12):1068-1078. doi: 10.1007/s00380-024-02456-9. Epub 2024 Sep 12.
The effect of the health insurance type on the prognosis of heart failure (HF) patients in Colombia and Latin America is poorly known. We aimed to analyze the characteristics of HF patients that participated in the Colombian Heart Failure Registry (RECOLFACA) as stated by their health insurance type and their relationship with the immediate prognosis of these patients. Patients with HF diagnosis were included in the RECOLFACA registry between 2017-2019. The registry was conducted in 60 centers in Colombia. All-cause mortality was the principal outcome. To evaluate the impact of health insurance on mortality, a Cox proportional hazards regression model was used. The Kaplan-Meier analysis was performed to compare survival probabilities according to insurance type. All statistical analyses were two-tailed and were considered significant with a p value < 0.05. Of the 2,528 participants enrolled in the registry, 99% held details about their health insurance. Of those, 897 patients (35.6%) were covered by public insurance. These patients were significantly younger, with a lower proportion of men, more frequently from rural origin, and lower prevalence of most comorbidities (omitting hypertension, chronic obstructive pulmonary disease (COPD), and Chagas disease) than those with private insurance. Furthermore, patients with public insurance had a worse functional class, as well as a poorer quality of life, and lower frequency of use of implantable devices, while exhibiting similar prescription rates of triple medical therapy for HF. Finally, no differences in short-term mortality were observed between the two groups (HR 1.09; 95% CI 0.79, 1.51). The type of health insurance represents a condition related with relevant differences in the profile of patients with HF in Colombia. Despite this, no significant differences were detected in the short-term prognosis of these patients based on the type of health insurance.
医疗保险类型对哥伦比亚和拉丁美洲心力衰竭（HF）患者预后的影响知之甚少。我们旨在分析参与哥伦比亚心力衰竭登记处（RECOLFACA）的 HF 患者的特征，这些患者的医疗保险类型及其与这些患者即时预后的关系。RECOLFACA 登记处于 2017-2019 年期间纳入了 HF 诊断患者。该登记处在哥伦比亚的 60 个中心进行。全因死亡率是主要结局。为了评估医疗保险对死亡率的影响，使用 Cox 比例风险回归模型。进行 Kaplan-Meier 分析以比较根据保险类型的生存概率。所有统计分析均为双侧检验，p 值<0.05 时认为差异具有统计学意义。在登记处登记的 2528 名参与者中，99%的人提供了其医疗保险的详细信息。其中，897 名患者（35.6%）参加了公共保险。与私人保险相比，这些患者明显更年轻，男性比例更低，更常来自农村，大多数合并症的患病率更低（不包括高血压、慢性阻塞性肺疾病（COPD）和恰加斯病）。此外，公共保险患者的功能分级较差，生活质量较差，植入式设备的使用频率较低，而 HF 的三联药物治疗处方率相似。最后，两组之间短期死亡率无差异（HR 1.09；95%CI 0.79, 1.51）。医疗保险类型代表了与哥伦比亚 HF 患者特征相关的重要差异条件。尽管如此，根据医疗保险类型，这些患者的短期预后并未发现显著差异。
