How patients with acute decompensated heart failure (HF) perceive how health care economic challenges are impacting health outcomes despite receiving life-sustaining drugs, China demonstrated in a prospective study.

Among more than 3,000 participants hospitalized with heart failure, those who reported severe perceived economic burden (PEB) had a higher 1-year mortality risk compared to those with lower PEB (HR 1.61, 95% CI 1.21 -2.13, P<0.001), Liwen Li, MD, PhD, of the Guangdong Cardiovascular Institute, China, and colleagues reported: JAMA network open.

Mean adjusted 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were lowest in patients with severe PEB at baseline and highest in patients with low PEB (40.0 vs. 50.2 on a 100-point scale) . P<0.001) and after 12 months (61.5 vs. 75.5; P<0.001). The difference in quality of life between severe and low PEB is considered clinically significant, with an average difference of 11.3 points in KCCQ scores at 1 year (P<0.001).

“Heart failure is a prevalent and deadly chronic disease that requires repeated testing, indefinite drug use, and even advanced equipment. “This scenario could put pressure on physicians to prescribe these options, ignoring costs,” Lee’s group wrote.

“However, our results also indicate that these costs may be detrimental by increasing PEB, thereby reducing the possibility that they may even completely neutralize the possible effects of these costly interventions. Yes,” they added.

Despite China having universal health care, there is significant underinsurance and out-of-pocket costs, said Paul Heidenreich, MD, MSc, of Stanford University School of Medicine in Palo Alto, California, in an accompanying editorial.

He noted that so-called “economic toxicity” (such as avoidance or delay of treatment, nonadherence to medication, and psychological distress) is common in the United States.

“In 2018, it is estimated that 1 in 7 U.S. households with a family member with heart failure spent more than 20% of their income on caregiving.For low-income households, this rate rose to 1 in 4. It was a household,” Heidenreich said. . “According to a Gallup poll in the US, approximately 46% of people will avoid medical care due to cost by 2022, and 70% of delays in treatment will be due to very serious or somewhat serious conditions. It was for.”

Mr. Heidenreich called for a change in cost-sharing policies.

There are a number of effective life-sustaining therapies available that are cost-effective for society in terms of survival and quality of life and are typically recommended as Class I in clinical guidelines, and are provided at no out-of-pocket cost to patients. “Should,” he wrote. “Patient cost-sharing should be reserved for drugs where treatment efficacy is small, uncertain, or cost-justified.”

The study enrolled 3,386 adult patients admitted to 52 hospitals in China with acute decompensated heart failure from 2016 to 2018. The researchers analyzed 1-year all-cause deaths and readmissions for heart failure, along with heart failure-specific health status from the KCCQ. The median age of participants was 67 years, and 62.5% of participants were male.

PEB was determined by responses to the question “How do you feel about your medical expense over the past year?” during the index hospitalization. 11.9% who answered that they were unable to bear the cost burden were classified as having severe PEB, and 59.7% who answered that they were “almost able” to bear the cost burden were classified as having moderate PEB. . In addition, 28.4% of respondents who answered that they could “easily cover” medical expenses were classified as having low PEB.

Only non-significant trends emerged for increased 1-year readmissions for severe heart failure and lower PEB (HR 1.21, 95% CI 0.98-1.49; P=0.07).

The authors acknowledged study limitations, including the observational design and potential confounders, and acknowledged that the concepts used to define PEB had not been validated with actual out-of-pocket medical costs. Also, approximately 40% of participants did not complete his KCCQ, and it is unclear whether this result can be generalized to people outside of China. They joined the editors in recommending further related research.

“National efforts need to be scaled up to identify practical approaches not only to reduce PEB in health care, but also to assess their potential impact to save lives and improve health outcomes. “Yes,” Lee and his co-authors advised. “In the face of the emerging heart failure epidemic, accounting for the association between perceived economic burden and health care outcomes is an important step toward more equitable and achievable care.”