Due to Cost, Heart Attack Patients Often Avoid Follow-up Care and Medication

A lack of funds to pay for medical treatment and prescriptions is common among heart attack patients and leads to a worse recovery, more angina, poorer quality of life and higher risk of re-hospitalization, according to a study by researchers at Yale School of Medicine.

Published in the March 14 issue of Journal of the American Medical Association (JAMA), the study sought to determine if self-reported financial barriers to health care services or medication were associated with worse patient outcomes. The 2,498 participants were part of the Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, multi-center U.S. study of patients with acute myocardial infarction (AMI) over 12 months. AMI is a common medical condition that requires continuing access to healthcare and guideline-based medications.

The researchers found that one in five patients in the PREMIER study reported that financial constraints kept them from seeking health care services. One in eight said a lack of funds kept them from filling prescriptions for vital medications. According to senior author Harlan M. Krumholz, M.D., this financial barrier to care was a strong predictor of adverse outcomes, even after controlling for other risk factors. Krumholz will present the paper at a JAMA media briefing at the National Press Club at 10 a.m. on March 13.

“Patients with financial barriers had a higher prevalence of angina, worse quality of life, and poorer overall physical and mental function, both at the time of their AMI and one year later,” said Krumholz, the Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale School of Medicine.

First author Ali R. Rahimi, M.D., said that the more severe clinical consequences were seen in those who couldn’t afford medications. “These patients had poorer health status outcomes overall and had a 50 percent higher chance of being re-hospitalized for any reason and a 70 percent higher chance of being re-hospitalized for a cardiac condition,” said Rahimi.

Having access to health insurance may not eliminate financial barriers to care, according to Krumholz. About 68 percent of the patients in the study who reported financial barriers to health care services had health insurance, and about 47 percent had Medicaid or Medicare coverage.

“Our study may be highlighting under-insurance, which can mean that too few services are covered or the coverage is inadequate; amounts of out-of-pocket expenditures are excessive, or insurance is perceived to be inadequate,” said Krumholz. “There is a need to develop approaches that will mitigate this increased risk and address this barrier to care and medications so that patients aren’t avoiding care or cutting pills in half.”

Other authors on the study included John A. Spertus, Kimberly J. Reid and Susannah M. Bernheim, M.D.

Citation: JAMA, Vol. 297, 10,  1063-1071, (March 14, 2007)