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Financial Stress and Outcomes after Acute Myocardial Infarction

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  • Sachin J Shah
  • Harlan M Krumholz
  • Kimberly J Reid
  • Saif S Rathore
  • Aditya Mandawat
  • John A Spertus
  • Joseph S Ross

Abstract

Background: Little is known about the association between financial stress and health care outcomes. Our objective was to examine the association between self-reported financial stress during initial hospitalization and long-term outcomes after acute myocardial infarction (AMI). Materials and Methods: We used Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER) data, an observational, multicenter US study of AMI patients discharged between January 2003 and June 2004. Primary outcomes were disease-specific and generic health status outcomes at 1 year (symptoms, function, and quality of life (QoL)), assessed by the Seattle Angina Questionnaire [SAQ] and Short Form [SF]-12. Secondary outcomes included 1-year rehospitalization and 4-year mortality. Hierarchical regression models accounted for patient socio-demographic, clinical, and quality of care characteristics, and access and barriers to care. Results: Among 2344 AMI patients, 1241 (52.9%) reported no financial stress, 735 (31.4%) reported low financial stress, and 368 (15.7%) reported high financial stress. When comparing individuals reporting low financial stress to no financial stress, there were no significant differences in post-AMI outcomes. In contrast, individuals reporting high financial stress were more likely to have worse physical health (SF-12 PCS mean difference −3.24, 95% Confidence Interval [CI]: −4.82, −1.66), mental health (SF-12 MCS mean difference: −2.44, 95% CI: −3.83, −1.05), disease-specific QoL (SAQ QoL mean difference: −6.99, 95% CI: −9.59, −4.40), and be experiencing angina (SAQ Angina Relative Risk = 1.66, 95%CI: 1.19, 2.32) at 1 year post-AMI. While 1-year readmission rates were increased (Hazard Ratio = 1.50; 95%CI: 1.20, 1.86), 4-year mortality was no different. Conclusions: High financial stress is common and an important risk factor for worse long-term outcomes post-AMI, independent of access and barriers to care.

Suggested Citation

  • Sachin J Shah & Harlan M Krumholz & Kimberly J Reid & Saif S Rathore & Aditya Mandawat & John A Spertus & Joseph S Ross, 2012. "Financial Stress and Outcomes after Acute Myocardial Infarction," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-10, October.
    • Handle: RePEc:plo:pone00:0047420
    DOI: 10.1371/journal.pone.0047420
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    References listed on IDEAS

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    1. Herman, P.M. & Rissi, J.J. & Walsh, M.E., 2011. "Health insurance status, medical debt, and their impact on access to care in arizona," American Journal of Public Health, American Public Health Association, vol. 101(8), pages 1437-1443.
    2. Illing, Mark & Liu, Ying, 2006. "Measuring financial stress in a developed country: An application to Canada," Journal of Financial Stability, Elsevier, vol. 2(3), pages 243-265, October.
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    2. Shervin Assari & James Smith & Ritesh Mistry & Mehdi Farokhnia & Mohsen Bazargan, 2019. "Substance Use among Economically Disadvantaged African American Older Adults; Objective and Subjective Socioeconomic Status," IJERPH, MDPI, vol. 16(10), pages 1-16, May.

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