The relationship between the socioeconomic status, including the health insurance status, and prognosis of heart failure (HF) has been recognized as an important concept for stratifying the risk in HF patients and is gaining increasing attention worldwide even in countries with a universal healthcare system. However, the impact of the Japanese health insurance status on outcomes among patients admitted for acute HF has not been fully clarified. We enrolled 771 patients admitted for acute HF between January 2018 and December 2019 and collected data on the in-hospital mortality, length of the hospital stay, and cardiac events, defined as cardiovascular death and readmission for HF within 1 year after discharge. Patients were divided into two groups according to their insurance status, i.e., public assistance (n = 87) vs. other insurance (n = 684). The public assistance group was significantly younger and had a higher rate of diabetes, smoking, ischemic and hypertensive heart disease, and low estimated glomerular filtration rate (all P < 0.05). Pharmacological/invasive heart failure therapy, in-hospital mortality, and the 90-day cardiac event rate after discharge did not differ between the groups. However, the public assistance group had a significantly higher 1-year cardiac event rate than the other insurance groups (P = 0.025). After adjusting for covariates, public assistance was independently associated with the 1-year cardiac event rate (HR: 2.15, 95% CI: 1.42–3.26, P < 0.001). Acute HF patients covered by public assistance received the same quality of medical care, including invasive therapy. As a result, no health disparities were found in terms of the in-hospital mortality and 90-day cardiac event rate, unlike overseas surveys. Nevertheless, HF patients with public assistance had a higher risk for the long-term prognosis than those with other insurance. Comprehensive HF management is required post-discharge.

包括健康保险状况在内的社会经济地位与心力衰竭 (HF) 预后之间的关系已被公认为是对 HF 患者进行风险分层的重要概念，并且即使在拥有全民医疗保健系统的国家也越来越受到全世界的关注。然而，日本健康保险状况对急性心衰患者结局的影响尚未完全阐明。我们招募了 2018 年 1 月至 2019 年 12 月期间因急性 HF 入院的 771 名患者，并收集了有关住院死亡率、住院时间和心脏事件的数据，心脏事件定义为出院后 1 年内因 HF 导致的心血管死亡和再入院。患者根据参保情况分为两组，即公费（n = 87) 与其他保险 ( n  = 684)。公共援助组更年轻，糖尿病、吸烟、缺血性和高血压性心脏病的发生率更高，估计肾小球滤过率较低（均P  < 0.05）。两组之间的药物/侵入性心力衰竭治疗、住院死亡率和出院后 90 天心脏事件发生率没有差异。然而，公共援助组的 1 年心脏事件发生率显着高于其他保险组（P  = 0.025）。调整协变量后，公共援助与 1 年心脏事件发生率独立相关（HR：2.15，95% CI：1.42-3.26，P < 0.001)。公共援助覆盖的急性心衰患者接受了相同质量的医疗服务，包括侵入性治疗。因此，与海外调查不同，在住院死亡率和 90 天心脏事件发生率方面没有发现健康差异。然而，与其他保险相比，有公共援助的 HF 患者的长期预后风险更高。出院后需要全面的 HF 管理。