For a young person recovering from a heart attack, affordable health care is crucial — for multiple reasons. Yale researchers have found that financial barriers are linked to worse outcomes for young patients in the year after a heart attack.
While the researchers hypothesized that young women with self-reported financial struggles may suffer worse outcomes than similarly positioned men, they instead found that both men and women experienced comparably worse outcomes when financial difficulties were reported.
“We found that in the year following a heart attack, financial barriers to health care are associated with worse health outcomes in young women and young men,” first author Adam Beckman ’16 said. “Specifically, those who reported experiencing financial barriers to health care services and medication reported worse quality of life, more depressive symptoms, poorer psychosocial status and more stress than patients without financial barriers, both while in the hospital and 12 months later.”
The study, which was published in the October issue of the Journal of the American Heart Association, used data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients. The VIRGO study — the largest prospective and observational study to date conducted for heart attack patients under 55 — was led by a team of Yale researchers, many of whom contributed to the October study.
Since there has been little research done about heart attacks in young people, the VIRGO study is unparalleled, said Martha Gulati, a specialist in women’s heart disease and the chief of cardiology at the University of Arizona. Gulati added that the October study was also unique in addressing sex differences in the financial barriers to recovering from a heart attack.
Data from the VIRGO study has been used in over 20 scientific papers thus far with the intent of gaining a better understanding of gender disparities in the outcomes of heart attacks, according to the VIRGO study’s website. According to the VIRGO web site, women under 55 are twice as likely as men to die from a heart attack. Beckman said that he and the researchers of the current study set out to establish whether there was a link between this and financial circumstances.
“We suspected women may experience greater challenges than men,” Beckman said, citing women’s propensity to have lower incomes, less complete medical coverage, and a multigenerational household to care for.
However, the team’s data did not support their initial hypothesis, as men who reported financial barriers were found to be as likely to experience a worse outcome following a heart attack as women. The researchers’ analysis and discussion instead noted an association between financial burdens and worsened outcomes for all young people.
In particular, the study recommended that doctors reassess their treatment plans for financially burdened patients, “given that patients with financial barriers may be discharged with evidence‐based secondary prevention treatments that they cannot afford.”
“A clear message of our study is that we cannot only focus on the uninsured; in the wake of the Affordable Care Act and expanded access to insurance, we need to pay attention to the negative effects underinsurance may also be having on patient outcomes,” Beckman said.
According to the published paper, some limitations of the VIRGO study may include a healthier than average sample population, a small sample size for certain financial barrier groups and a lack of one-year outcomes for approximately one quarter of study participants.
In light of the study’s findings, Gulati stressed the importance of affordable secondary care — the ability to afford a disease’s management, after having contracted it.
“If we truly want to improve health outcomes, we must make sure patients have access to care and medications, without financial barriers,” she said. “We can’t change it if we don’t.”
Additionally, the study revealed young age as a variable that can impact prognosis, Gulati said. She pointed to a need for further research in order to determine why young women have poorer outcomes than men following a heart attack.
In 2015, over 15 percent of Americans aged 19–25 did not have health insurance, according to the Centers for Medicare and Medicaid Services.