About one in five heart attack patients report having financial barriers to health care services, and these patients are more likely to have a lower quality of life and increased rate of rehospitalization, according to a study in the March 14 issue of JAMA, a theme issue on access to care.
Harlan M. Krumholz, M.D., S.M., of the Yale University School of Medicine, New Haven, Conn., presented the results of the study today at a JAMA media briefing on access to care at the National Press Club.
According to background information in the article, more than 16 million Americans avoid health care due to cost or have trouble affording their medications despite having health insurance. Patients who have difficulty affording health care may have an increased risk for poor health outcomes, though few studies have directly investigated this.
Dr. Krumholz and colleagues conducted a study to determine if self-reported financial barriers (as defined by avoidance due to cost) to health care services or medication were associated with worse outcomes for patients recovering from an acute myocardial infarction (AMI; heart attack). Patients were followed for the year after the heart attack to examine the association of their reported financial barriers with a range of outcomes including death, rehospitalization, and health status. The Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER) study included 2,498 patients with AMI who were enrolled from January 2003 through June 2004.
Participants were surveyed at the time of their hospitalization concerning their overall health status and were asked whether they avoided health care services in the prior year due to costs and whether they did not take prescribed medication as instructed due to cost.
The researchers found that the prevalence of self-reported financial barriers to health care services or medication was 18.1 percent and 12.9 percent, respectively. Of the individuals who reported financial barriers to health care services or medication, 68.9 percent and 68.5 percent, respectively, were insured.
By 12 months, individuals who reported financial barriers to health care services had a 12.1 percent higher prevalence of angina; a 11.2 percent higher all-cause rehospitalization rate and an 8.0 percent higher cardiac rehospitalization rate. At one year, individuals who reported financial barriers to medication had a 17 percent higher prevalence of angina; a 19.2 percent higher all-cause rehospitalization rate and a 16.4 percent higher cardiac rehospitalization rate. At 1-year follow-up, individuals with financial barriers to health care services or medications were more likely to have a lower quality-of-life score.
“Financial barriers to health care, as defined by self-reported avoidance of health care services or medication due to cost, are a common and potent risk factor for adverse outcomes in the AMI population,” the authors write. “The findings may be helpful to improve risk stratification of patients and to address structural issues in the health care system predisposing certain patients to worse outcomes. This study provides further support for improved needs assessment and discharge planning combined with a mechanism to facilitate implementation of discharge plans.”