Accessibility to health care of diabetic patients with acute coronary syndrome ST-segment elevation

Abstract

Objectives: To measure accessibility to health care among diabetic patients and analyze whether differences in delay explain differences in hospital mortality. Methods: A retrospective cohort study was conducted in diabetic patients with acute coronary syndrome with ST-segment elevation included in the ARIAM-SEMICYUC registry (2010---2013). Crude and adjusted analyses were performed using unconditional logistic regression. Results: A total of 4817 patients were analyzed, of whom 1070 (22.2%) were diabetics. No differences were found in access to health care between diabetic and non-diabetic patients. Diabetic patients presented with longer patient delay (90 min vs. 75 min; p = .004) and prehospital delay (150 min vs. 130 min; p = .002). Once the health system was contacted, diabetic patients had a lower reperfusion rate (50% vs. 57.7%; p < .001), but no longer delay in treatment was observed compared with the non-diabetic individuals. Diabetic patients have greater in-hospital mortality (12.5 vs. 6%; p < .001), though neither patient delay nor prehospital delay was identified as independent predictors of in-hospital mortality. Conclusions: Diabetic patients had a longer delay in access to health care, though such delay was not independently related to increased mortality.

Objetivos: El objetivo de este estudio es medir la accesibilidad al sistema sanitario de los pacientes diabéticos y analizar si las posibles diferencias en la accesibilidad explican la mayor mortalidad conocida en aquellos. Métodos: Estudio de cohortes retrospectivo, realizado en pacientes diabéticos con síndrome coronario agudo con elevación del segmento ST incluidos en los a˜nos 2010 al 2013 del registro ARIAM-SEMICYUC. Se realiza análisis crudo y ajustado mediante regresión logística no condicional. Resultados: Se han analizado 4817 pacientes, de los cuales 1070 (22,2%) son diabéticos. Los pacientes diabéticos contactan con el sistema sanitario de la misma forma que los pacientes no diabéticos aunque con mayor retraso (retraso atribuible al paciente 90 min vs. 75 min con p = 0,004 y retraso prehospitalario 150 min vs. 130 min con p = 0,002). Una vez dentro del sistema sanitario, estos pacientes tienen menor tasa de reperfusión (50 vs. 57,7%; p < 0,001) pero sin objetivar mayor retraso en el tratamiento. Como ya es conocido, los pacientes diabéticos presentan una mayor mortalidad hospitalaria (12,5 vs. 6%; p < 0,001); sin embargo, no se identifican como variables predictoras independientes de la mortalidad ni el retraso atribuible al paciente ni el retraso prehospitalario. Conclusiones: Los pacientes diabéticos tienen una mayor demora en el acceso al sistema sanitario, sin embargo no hemos podido objetivar que esta demora se relacione de forma independiente con la mayor mortalidad.