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Financial Barriers to Recovery 1 Year After MI

Data from the PREMIER registry suggest underinsurance as a potential culprit.

We have few prospective, longitudinal studies on how financial obstacles to healthcare relate to clinical outcomes. To enhance the evidence base, researchers prospectively studied 2498 adults hospitalized with acute MI from January 2003 through June 2004. All were enrolled in PREMIER, a 19-center U.S. MI registry.

During their hospital stays, patients were asked whether, in the past year, they had avoided obtaining healthcare services because of cost and how often during that period they had not taken prescribed medications because of cost. Of the cohort, 18% reported financial barriers to use of healthcare services, and 13% reported financial barriers to medication use.

Patients with financial barriers to use of healthcare services were, at 1-year follow-up, significantly more likely to report angina (30% vs. 18%), had significantly lower health-status and quality-of-life scores, and had significantly higher rehospitalization rates (49% vs. 38%) than their counterparts without such barriers. All but the angina difference held after adjustment for potentially confounding demographic, clinical, and inpatient care (e.g., coronary angiography and revascularization) variables.

Patients with financial barriers to medication use were significantly more likely to report angina at 1-year follow-up (35% vs. 18%), had significantly lower health-status and quality-of-life scores, and had significantly higher rehospitalization rates (57% vs. 38%) than their counterparts without such barriers. All differences held after adjustment for potential confounders.

Comment: In this prospective, longitudinal study, financial barriers to use of healthcare services — and especially to medication use — were associated with disadvantages in angina, health status, quality of life, and rehospitalization 1 year after hospitalization for acute MI. Mortality numbers were too small to permit meaningful assessment. More than two thirds of the patients who reported financial barriers had health insurance, suggesting that underinsurance likely plays a role. We need more studies in larger populations, both to document the problem’s magnitude and to identify potential solutions. The present study is an important step toward those goals.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology March 21, 2007

Citation(s):

Rahimi AR et al. Financial barriers to health care and outcomes after acute myocardial infarction. JAMA 2007 Mar 14; 297:1063-72.

• Original article (Subscription may be required)
• Medline abstract (Free)

Fontanarosa PB et al. Access to care as a component of health system reform. JAMA 2007 Mar 14; 297:1128-30.

• Original article (Subscription may be required)
• Medline abstract (Free)