Nearly 1 in 6 Heart Failure Patients Delay or Avoid Care, Half Cite Financial Reasons

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Among US patients with heart failure, approximately 1 in 6 either delay or go without medical care for their symptoms, driving up the cost of care later, according to study findings published in JACC: Heart Failure. More than half of those patients, investigators found, attributed deferral of care to financial constraints.

As context for their study, researchers, led by Alexander Thomas, MD, department of internal medicine at Yale University School of Medicine, point to a projected 3-fold increase in direct and indirect spending on HF from 2012-2030 and to an absence of information on the proportion of HF patients who forego/delay care and impact on future health care expenditures. 

Thomas and colleagues reviewed health care spending and utilization between 2005 and 2015 for 259 594 participants in the national Medical Expenditure Survey, a series of cross-sectional surveys with data on demographics, diagnoses, prescriptions, health care usage, etc. Of that group, 2,050 had a diagnosis of HF. Patients with HF who reported delayed/foregone care or medical treatment were compared with those not reporting care lapses.

Their analysis found that 16% of HF patients surveyed said they had either foregone care entirely or delayed it. Of those patients,10% were aged ≥65 years (elderly) but 27% were aged <65 years (nonelderly). Factors significantly associated with foregoing or postponing care included age <65 years, lower household income (55.2%) and higher burden of cardiac risk factors (59.3%).

Financial constraints were the most common reasons for not obtaining care, including being unable to afford care, lacking insurance, or having an insurance carrier that would not approve or pay for the care. Financial issues were more problematic for those aged <65 years (60%) vs those aged ≥65 years (47%).

Thomas and colleagues found that although delaying or forfeiting care was not associated with risk of future hospitalization, it was linked to total annual healthcare expenditures $8027 higher for those patients that for those who did not avoid care. This was particularly true among the patients aged ≥65 years.

In the elderly group, care avoidance was associated with more emergency department visits vs for the younger group (43% vs 58%; P < .05), with $7,548 more in inpatient costs, and 10 581 more total health care costs.

According to the authors, the study is the first to define the link between forgone/delayed care in the HF population and health care use or costs.

“Forgone/delayed care was associated with significantly higher health care spending in the overall HF population, especially among the elderly, and may be contributing to the rising costs of HF over time,” wrote Thomas and colleagues. “Efforts to address the underlying causes of forgone/delayed care, targeted at the demographic groups identified to be most at risk, may help to improve patient outcomes while also reducing costs."

Reference: Thomas A, Valero-Elizondo J, Khera R, et al. Foregone medical care associated with increased health care costs among the US heart failure population. J Am Coll Cardiol HF. Aug 11, 2021. DOI: 10.1016/j.jchf.2021.05.010