Yale Bulletin and Calendar

March 30, 2007|Volume 35, Number 23

Study shows financial barriers contribute to less follow-up care for heart attack patients

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 the 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 health care 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 Dr. Harlan M. Krumholz, the Harold H. Hines Jr. Professor of Medicine and Epidemiology and Public Health at the School of Medicine, this financial barrier to care was a strong predictor of adverse outcomes, even after controlling for other risk factors.

"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," says Krumholz.

Dr. Ali R. Rahimi, first author on the study and a resident in internal medicine, says 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% higher chance of being re-hospitalized for any reason and a 70% higher chance of being re-hospitalized for a cardiac condition," says Rahimi.

Having access to health insurance may not eliminate financial barriers to care, according to Krumholz. About 68% of the patients in the study who reported financial barriers to health care services had health insurance, and about 47% 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," says 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 Dr. Susannah M. Bernheim.

-- By Karen Peart

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