The effect of the public or private status of health care facility in acute coronary syndrome: Data from Thai ACS registry

Abstract

Background: Few data showed the differences between public and private hospitals in management practices and outcomes of patients with acute coronary syndrome. Furthermore, no data is available in Thailand. Objective: To determine the patients' characteristics, management practices, and in-hospital outcomes differences between public and private hospitals in Thailand for patients with acute coronary syndrome. Material and Method: Data from the Thai Acute Coronary Syndrome Registry (TACSR), which was a prospective observational study on ACS in Thailand from 2003 to 2005, was used. This registry provided clinical characteristics, medical management and outcomes of patients with ACS during hospitalization. All data were then compared based on type of admitting hospitals; public and private hospitals. To determine the relationship between type of hospital and major cardiac outcomes, multivariate logistic regression analysis was performed and represented as odd ratio(OR) and 95% confidence interval (95%CI). Results: Eight thousand one hundred sixty four patients were admitted to public hospitals (n = 13), and 1,209 were admitted to private hospitals (n = 4). Patients in public hospitals were older (65.4 ± 12.1 vs. 63.4 ± 13.3 years, p < 0.001) and more female gender (41.7% vs. 30.1%, p < 0.001). Diagnosis of acute ST-elevation myocardial infarction were lower in public hospitals compared to private hospitals (39.6% vs. 50%, p < 0.001). After adjusting for baseline patient characteristics and management, in-hospital outcomes were higher in public hospitals for total mortality (13.6% vs. 5.9%, OR 2.3, 95%CI 1.76-3.12, p < 0.001), cardiac mortality (10.6% vs. 4.8%, OR = 2.1, 95%CI 1.55-2.91, p < 0.001) and major bleeding (6.3% vs. 3.2%, OR = 2.1, 95%CI 1.48-3.23, p < 0.001). Compared with the patients in the public hospital, patients in the private hospitals were more likely to undergo coronary angiography, percutaneous coronary intervention and coronary bypass grafting. Conclusion: In Thailand, management of patients with acute coronary syndrome is influenced by the public or private status of the hospitals. Patients were more likely to undergo coronary angiography and coronary revascularization procedures in private hospitals. The length of hospital stays and in-hospital mortality was higher in public hospitals.