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Nearly half of adults with heart disease can't afford their medical bills

February 11, 2019

New Haven, Conn. -- More than 45% of non-elderly adults with atherosclerotic cardiovascular disease (ASCVD) report financial hardship due to the associated medical bills, according to a Yale research team. Worse still, about one in five report being unable to pay those medical bills at all, said the researchers.

This study appears in the Journal of the American College of Cardiology.

According to the study, which was scaled up from the data sample provided by the 2013-2017 National Health Interview Survey, the non-elderly American adults with ASCVD experiencing medical bill-related financial hardship represents an estimated 3.9 million individuals.

"It is remarkably disheartening to see how many people suffer severe financial adverse effects of having atherosclerotic cardiovascular disease," said Harlan Krumholz, M.D., Yale cardiologist and director of the Yale Center for Outcomes Research and Evaluation (CORE). "We have much work to do to ensure that people are spared the financial toxicity of disease that is imposed by our current healthcare system."

Of the group who indicated financial hardship, more than one in three reported that they have also experienced significant financial distress, cut back on purchasing basic necessities like food, and/or skimped on taking essential but costly medications in response to the burden of their medical bills.

ASCVD patients with financial hardship were skimping on medication at the same rates regardless of their income level and insurance status -- contradicting earlier research that suggested cost-related medication nonadherence is present mostly in low-income families or older minorities. The researchers also found that for the 19% who are unable to pay their medical bills at all, the majority were insured.

"While one may expect financial hardship to predominantly affect those without insurance, we found that the majority of individuals with ASCVD suffering from financial hardship were insured, pointing towards inadequate protection with greater cost shifting towards patients and their families," said Javier Valero-Elizondo, M.D., lead author and postdoctoral associate at Yale CORE. "Broader policy actions will be needed to mitigate exposure to perils of underinsurance."

Khurram Nasir, M.D., senior author and a faculty member at Yale CORE and in the Section of Cardiovascular Medicine at the Yale School of Medicine, concluded that this study "sends a strong message to all stakeholders in our cardiology community that financial hardship induced by medical bills isn't just rhetoric for the millions of patients and their families suffering from heart disease and stroke: It's something we can no longer afford to ignore."

"This brewing burden will likely act as a key catalyst in driving a major policy shift toward a single-payer healthcare system in the United States," said Nasir.
Other authors include Rohan Khera, Anshul Saxena, Gowtham R. Grandhi, Salim S. Virani, Javed Butler, Zainab Samad, and Nihar R. Desai.

Disclosures for all potential conflicts of interest can be found in the study.

Yale University

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