To the Editor: Dr Smolderen and colleagues1 found that both lack of insurance and concerns about costs among patients with insurance were associated with delays in seeking emergency care for acute myocardial infarction (AMI). They also found that an increased prehospital delay was associated with receiving less subsequent primary reperfusion therapy. Their observations are consistent with the treatment-risk paradox: high-risk patients are the ones who are least likely to access appropriate medical care.
Jerry van Riezen, Peter de Jonge. Insurance and Financial Concerns Among Patients Seeking Care for Acute Myocardial Infarction. JAMA. 2010;304(5):523–524. doi:10.1001/jama.2010.1070