Financially burdened patients more likely to die after coronary revascularization

Heart patients who had angioplasty or bypass surgery and felt burdened by medical costs were more than twice as likely to die within a year of their procedure as patients who didn’t have trouble paying for healthcare, according to a study presented today at the American Heart Association’s 5^th annual Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

Many studies have found an association between socioeconomic status and cardiovascular death, but they had not analyzed how patients’ perceptions of economic burden affect cardiovascular survival.

In this study, 2,097 patients undergoing either angioplasty or coronary artery bypass surgery participated in a survey in 1999 to 2000 to examine recovery and health status outcomes, including symptoms, physical function and quality of life, said lead author Carole J. Decker, R.N., Ph.D. 

Participants were asked, “Have your medical costs been an economic burden to you over the past year?”  They responded using a five-point scale, and researchers classified patients who said they were “somewhat” to “severely” burdened as “burdened.”  Those reporting less burden were classified as “non-burdened.”

They found that 547 patients (26 percent) perceived themselves as economically burdened.  Those who reported feeling burdened tended to be slightly younger — average age 64.1 years versus 66.5 in the non-burdened group.  Thirty-four percent of the burdened group was female, versus 27 percent of the non-burdened group.  People in the burdened group were more likely to have received angioplasty versus surgery to unblock arteries, and they also tended to have other diseases such as diabetes, congestive heart failure, high blood pressure, chronic obstructive pulmonary disease (COPD) or a previous heart attack.

The burdened group had a 5.9 percent mortality rate one year later, compared with 3.5 percent for the non-burdened group.

“This effect was independent of type of procedure (angioplasty or surgery) and other disease conditions,” said Decker, a project manager of Cardiovascular Outcomes Research in the Mid America Heart Institute at Saint Luke’s Hospital in Kansas City, Mo. 

Decker and colleagues conclude that patients’ perceptions of their ability to afford healthcare are variables that can affect survival, even after having received access to cardiac care.  Healthcare cost burden is not a risk factor commonly considered when assessing patients, as is blood pressure or medical history.  But it might indicate that patients who view healthcare as an economic burden could be at higher risk of death after their procedures, Decker said.

“One of the aims of future studies should be to determine whether our findings can be replicated at other hospitals,” Decker said.  “We also need to better understand what the actual burden is: Is it medication, transportation to healthcare, time away from work?  Only then can society take steps to decrease the burden and possibly impact these patients’ survival.”

Co-authors are Mark McPhee, M.D., MHCM; John Spertus, M.D., M.P.H.; and Phil Jones, M.S. http://www.americanheart.org