Older adults under severe financial strain more likely to die within six months after heart attack

Older adults who report being under severe financial strain were substantially more likely to die within six months of having a heart attack compared to those with moderate or no financial strain, according to a new study led by University of Maryland School of Medicine (UMSOM) researchers. The findings were published last month in JAMA Internal Medicine and point to glaring disparities in medical outcomes due to financial circumstances.

Our research indicates the importance of financial strain in predicting which patients will survive severe health conditions."

Jason Falvey, PhD, Study Author, Assistant Professor of Physical Therapy and Rehabilitation Science at UMSOM

In the study, he and his colleagues from Yale School of Medicine examined data from nearly 3,000 participants of the SILVER-AMI study, which tracks the health outcomes of adults aged 75 and over who have had heart attacks. They found nearly 17 percent of older adults under severe financial strain (not having enough money to make ends meet each month) died within six months of being discharged from a hospital after a heart attack. That compares to 9 percent of those with moderate financial strain and 7 percent of those with no financial strain.

After adjusting for chronic conditions and other health factors, Dr. Falvey and his colleagues found that being under severe financial strain increased the risk of death by 61 percent compared to those who had moderate or no financial strain. While the study did not identify reasons for why economic hardship would increase the likelihood of dying, lack of access to vital medications and transportation barriers to follow-up healthcare appointments could play a role, according to Dr. Falvey. Biological stressors, such as elevated inflammation, are also associated with financial strain and likely an important factor.

"Many of the participants in our study under severe financial strain were not living below the poverty line or enrolled in safety net options such as Medicaid," Dr. Falvey said. "This means we would have no way of knowing who these patients are if we do not ask this question when we take their medical history."

Hospitals should consider asking this question during discharge planning to help identify those patients who are particularly vulnerable to worse health outcomes due to their financial circumstances, he recommended. Social workers and other hospital staff could then arrange for referrals to free or subsidized transit services, programs that assist with medication co-payments for low-income individuals, or community organizations who can provide or loan needed durable medical equipment and devices.

"This is an important finding that points to the need to identify and address economic disparities in our patient population," said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. "We see a real cost in terms of shorter lives in those patients who cannot make ends meet every month, that may not be due to the limits of medical care, but to our inability to provide these patients with access to that care and the services they need."