Even Among the Insured, Patients With Cardiovascular Disease Face Financial Toxicity

Atherosclerotic cardiovascular disease (ASCVD) is not only a leading cause of mortality among US adults, but also responsible for high medical costs that burden both the healthcare system and individual patients. New research shows that 1 in every 5 patients with ASCVD is unable to afford his or her medical bills, and even among patients with insurance, financial hardship related to medical costs is prevalent.

The study, slated for publication in the Journal of the American College of Cardiology, drew upon data from 2013 to 2017 from the National Health Interview Survey. Responses from patients who self-reported a diagnosis of coronary or cerebrovascular disease were included in the study, which defined financial hardship as having problems paying medical bills in the past year or needing to pay medical bills off over time. Financial distress was derived from questions related to patients’ level of worry about their ability to pay for such necessities as monthly bills or housing costs.

In total, 6160 of the survey’s respondents aged 18 to 64 reported having ASCVD, and 45.1% (95% CI, 43.4%-47.7%) reported that they had financial hardship related to medical bills. Additionally, 18.9% (95% CI, 17.6%-20.2%) reported that they were unable to pay their medical bills at all. Those who were unable to pay their bills had higher odds of financial distress, food insecurity, and cost-related medication nonadherence compared with patients who did not report financial hardship related to medical bills.

While the highest burden of financial hardship related to medical costs was reported by uninsured and low-income patients, patients who were insured were not immune from the financial toxicity of ASCVD. Among those with insurance, 27% reported financial hardship, and 16.4% reported an inability to pay their bills (versus 20.5% and 38.3%, respectively, among those without insurance.

While the authors note that their study is limited by the fact that it cannot show causality (food insecurity, for example, could contribute to problems paying off medical bills), and the survey questions assessed household financial hardship rather than individual financial hardship, they write that their findings show that the US healthcare system is failing to protect patients with ASCVD from the consequences of financial toxicity.

"It is remarkably disheartening to see how many people suffer severe financial adverse effects of having atherosclerotic cardiovascular disease," said Harlan Krumholz, MD, cardiologist and director of the Yale Center for Outcomes Research and Evaluation (CORE), in a statement on the findings. "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."

Khurram Nasir, MD, senior author and a faculty member at Yale CORE and in the section of cardiovascular medicine at the Yale School of Medicine, added 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."

Reference

Valero-Elizondo J, Khera R, Saxena A, et al. Financial hardship from medical bills among nonelderly US adults with atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2019;73(6): 727-732. doi: 10.1016/j.jacc.2018.12.004.