The Effect of the Public or Private Status of Health Care Facility in Acute Coronary Syndrome: Data from Thai ACS Registry
Pisit Hutayanon MD*, Pongdech Sarakarn **, Adisai Buakhamsri MD*, Wattana Boonsom MD****, Sukit Yamwong MD*****
Affiliation : * Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani ** Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen **** Department of Medicine, BMA Medical College and Vajira Hospital, Bangkok ***** Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
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.
Materials and Methods : Data from the Thai Acute Coronary Syndrome Registry (TACSR), which was a prospec-
tive 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.
Keywords : Acute coronary syndrome, Health care facility, The Thai Acute Coronary Syndrome Registry
