Effect of health insurance coverage on outcome for heart failure in high-risk patients.

Lack of health insurance is linked to adverse patient outcomes. To evaluate the effect of health insurance on clinical outcome in patients with chronic heart failure. Retrospective cohort study to all patients admitted with a diagnosis of heart failure at a university hospital in Louisiana during 2003-2004. Patients were divided into four groups: group 1, uninsured; group 2, government insurance covering services and medications; group 3, government insurance covering professional services only and group 4, commercial insurance. Outcome measures were in-hospital death, readmission rates and average serum markers of heart failure during the follow-up period. Six hundred forty-six patient records were reviewed; 70 patients in group 1, 167 in group 2, 96 in group 3 and 24 in group 4. The four groups differed significantly in age, ethnicity, presence of ischemic heart disease, proportions of alcohol abuse and proportions of illicit drug use. Multiple linear and logistic regression analyses showed that health insurance coverage was not a significant predictor of any outcome measure. Presence and type of health insurance coverage for heart failure patients at a university hospital in Louisiana were not associated with improved clinical outcome. Significant social differences exist between patients' group in relation to their insurance status.