Association between health insurance status and transfer of patients with return of spontaneous circulation after out-of-hospital cardiac arrest

Abstract

Aim: To explore the factors related to the probability of inter-hospital transfer to a heart attack centre in patients with return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA) in the Republic of Korea. Methods: This cross-sectional observational study used data from a Korean national emergency medical service OHCA database for cases between 2015 and 2017. Adult OHCA patients with a presumed cardiac origin who initially presented at a non-heart-attack centre were included in the analysis. The main exposure variable was health insurance type (national health insurance versus medical aid), which was used as a proxy measure of individual socioeconomic status. The primary outcome was emergency department disposition (transfer to a heart attack centre versus no transfer). A multivariate logistic analysis using propensity score matching was conducted. We also analysed the associations between patient transfer and neurologic recovery as well as survival to discharge. Results: Of 7804 eligible OHCA patients, 1804 23.0%) were transferred to a heart attack centre. Patients on medical aid were less likely to be transferred (adjusted odds ratio [OR], 0.75; 95% confidence interval [CI], 0.59–0.95 in a matched cohort) compared with patients with national health insurance. Transfer to a heart attack centre was significantly associated with a lower risk of death (adjusted OR, 0.38; 95% CI, 0.33–0.45) and better neurologic recovery (adjusted OR, 0.46; 95% CI, 0.38–0.56). Conclusion: Socioeconomic status appears likely to influence the probability of transfer to a heart attack centre after resuscitation.