Financial Burden Raises Risk of Death Among Elders Post MI: JAMA
At a time of increasing health care costs, patients commonly face substantial financial barriers to obtaining needed health care. In a recent study, researchers have re-iterated that older adults with severe financial strain had a greater risk for mortality 6 months after being discharged from the hospital for acute myocardial infarction. The study findings were published in the JAMA Internal Medicine on February 21, 2021.
Severe financial strain among older adults is associated with lower medication adherence which may negatively affect recovery for older adults following an AMI. However, the relationships between financial strain and AMI outcomes for older adults have not been evaluated. Therefore, Dr Jason R. Falvey and his team hypothesized that severe financial strain would be associated with elevated mortality risk following an AMI.
The researchers analyzed data on 2,851 patients age 75 or older enrolled in the multicenter, longitudinal cohort SILVER-AMI trial who were discharged with complete data on financial strain between January 2013 to June 2017 after an acute MI. They categorized patients' responses based on self-reported measures into the following groups:
- None (more than enough money to make ends meet each month),
- Moderate (just enough to make ends meet), or
- Severe (not enough to make ends meet).
The major outcome assessed was mortality rates among those with no financial strain, moderate financial strain and severe financial strain in 180 days after discharge.
Key findings of the study:
- Upon analysis, the researchers found that severe financial strain was associated with a 61% increase in 180-day mortality risk (HR = 1.61) compared with adults with no strain.
- They observed no significant association between moderate financial strain and an increased risk for mortality (HR = 1.04).
- They noted that the results were comparable when adjusting for sex among those with severe strain (HR = 1.6) and those with moderate strain (HR = 1.04).
The authors concluded, "Financial strain for older adults is a growing concern, and patient-level interventions are necessary but probably insufficient to ameliorate the downstream consequences"
They further added, "Larger policy interventions, like increasing affordable housing and addressing transportation barriers for older adults, are likely needed to reduce socioeconomic inequities in care outcomes after [acute] MI."
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