Poor Heart Disease Patients Pay More For Medications, Get Less Preventative Care

March 31, 1998

ATLANTA - Doctors know that heart disease patients who have a limited education and few economic resources are more likely to die, but now researchers at Duke University Medical Center are beginning to learn why: many can't pay for life saving medications and don't receive preventative care.

Cardiologist Chen Tung and his Duke colleagues prepared their findings for presentation Tuesday at the 47th scientific sessions of the American College of Cardiology. The study is part of a National Institutes of Health-funded "Moderators of Social Support (MOSS)" study.

"It's well known that heart patients with low socioeconomic status do not do as well as other heart disease patients," Tung said. "We focused on how lower income may affect how long people live."

Patients with less than nine years of education and an income of less than $10,000 per year also were older, more likely to be female and had more hypertension. Frequently, these patients are living on a fixed income without adequate insurance to cover medication costs. They also receive less cardiac rehabilitation, according to the study of 523 heart disease patients at Duke.

"This should be a wake-up call to physicians and the health care industry in this cost-conscious age," said Tung. "Right now there are no interventions specific to cardiac patients with low incomes and limited education to improve their survival."

The patients all received cardiac catheterization, which confirmed coronary artery disease, and were prescribed medicine to control their disease. One month later, patients were interviewed about their medications, out-of-pocket medication costs and whether they had not taken their medications because of cost. After six months, doctors followed up with patients to determine what preventive or emergency visits they had.

The study revealed that heart disease patients with an income of less than $10,000 per year and less than nine years of education had more emergency room visits, but received fewer cardiac rehabilitation visits than other patients. They also paid on average more than $100 per month out-of-pocket for medication, versus $58 per month for people who made more than $20,000 per year. As a result, 20 percent of the low income patients had cut down or stopped taking medication, versus just 2 percent of the highest income group, those who made more than $45,000 annually.

"Most of these lower income patients were uninsured or on Medicaid," Tung said. "They are living on fixed incomes of less than $800 a month and many have out-of-pocket medication costs of $100 to $150 a month. If it comes down to a choice between paying the rent, buying food or taking medications, the medication is going to go first.

"If poor cardiac patients are not able to afford life saving medications, such as beta-blockers, ACE inhibitors, and cholesterol-lowering agents, it is not surprising that these patients don't do as well," he said.

In addition, lifestyle factors are well known to contribute to longevity, Tung said. Services such as cardiac rehabilitation programs teach heart disease patients good dietary habits, and start a safe, monitored exercise routine. Fewer of the low income patients used these services.

"Our findings showed patients with low socioeconomic status tended to wait until they are really sick before seeking medical care," Tung said. "Often by this time the disease has progressed much more extensively."

In fact, the lowest income patients had more than twice as many emergency visits, but received virtually no cardiac rehabilitation visits.

"At the very least, this points out a dire need for programs that provide assistance for medication for low-income individuals," Tung said. "No one should have to choose between food and medication."

Duke researchers Lai Choi Lam, Nancy Clapp-Channing, Barbara Lytle, Drs. Redford Williams, John Barefoot, Ilene Siegler, and Daniel Mark also contributed to the studies.

Duke University Medical Center

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