[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 were 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.

Keywords: Accesibilidad; Access; Acute coronary syndrome with ST-segment elevation; Delay; Diabetes mellitus; Health care; Retraso; Sistema sanitario; Síndrome coronario agudo con elevación de ST.