In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia.

BACKGROUND: The National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS). METHODS: This is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis. RESULTS: We observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001). CONCLUSIONS: This study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.

Utility of Oral Quinine Sulfate for the Treatment of Brugada Syndrome Presenting as Electrical Storm in Remote Areas: Resilience in the COVID-19 Era.

Electrical storm is a malignant presentation of Brugada syndrome (BrS). Pharmacologic antiarrhythmic therapy is mandatory for this condition, followed by implantation of an implantable cardioverter-defibrillator to prevent sudden cardiac death. We report a case of a BrS patient presenting with electrical storm in a remote area. A referral to tertiary healthcare services was turned down due to the capacity demands of COVID-19 cases. Oral quinine was used as a bailout therapy and successfully maintained the arrhythmia suppression. Our case confirms that quinine is a reliable option to suppress electrical storm in BrS.

L'orage rythmique est une manifestation néfaste du syndrome de Brugada (SBr). Une pharmacothérapie antiarythmique s'avère incontournable dans ce contexte et doit être suivie de l'implantation d'un défibrillateur cardioverteur afin de prévenir la mort subite par arrêt cardiaque. Nous présentons le cas d'un patient atteint du SBr ayant subi un orage rythmique dans une région éloignée. Son orientation vers des services de soins de santé tertiaires a été refusée en raison de la mobilisation des ressources par les cas de COVID-19. Un traitement de sauvetage par la quinine administrée par voie orale a été instauré et a permis de maintenir la suppression des arythmies. Le cas de ce patient confirme que la quinine représente une option fiable pour arrêter un orage rythmique chez un patient atteint du SBr.