Comparison of Baseline Characteristics and In-hospital Outcomes in Medicaid Versus Private Insurance Hospitalizations for Atrial Fibrillation

The prevalence of atrial fibrillation (Afib) has been increasing over the past few decades. There are very few comparisons of health insurance plans available that incorporate measurement of co-morbidities and in-hospital outcomes. We sought to compare an impact of Medicaid versus private insurance (PI) on outcomes in hospitalizations with Afib. The US National Inpatient Sample database from years January 2010 to September 2015 was used to identify adult (>= 18 years) Afib hospitalizations, whose payment source was either Medicaid or PI. We included propensity score-matched analysis for comparison of outcomes between the groups. In a total of 3,264,258 Afib hospitalizations, 22.9% hospitalizations were insured with Medicaid, while 77.1% had PI. Compared with PI, Medicaid beneficiaries (MB) were younger (59 vs 64 years), fewer were men (55.15% vs 63.16%), and fewer were Caucasians (52.66% vs 81.67%; all p < 0.0001). As suggested by Charlson co-morbidity index >= 3, more MB (40.86 %) had the significantly higher burden of co-morbidities compared with PI (29.87%; p < 0.0001). About 83% of Afib hospitalizations had a CHA2DVASC2 score >= 2 in both the groups. After adjusting for confounders, in-hospital mortality was significantly higher (4.8% vs 4.3 %, p = 0.02) in MB compared with PI. In MB, 55.3% hospitalizations were discharged to home and their median length of hospital stay was 5 days, whereas 61.3% hospitalizations with PI were discharged to home and their median length of stay was 4 days (p < 0.0001). In conclusion, this extensive study of Afib hospitalizations, Medicaid group had greater co-morbidities, marginally higher in-hospital mortality, longer length of stay, and lesser disposition to home as compared with PI group. (C) 2018 Elsevier Inc. All rights reserved.