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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."
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