Financial difficulties and patient-reported outcomes among patients with advanced heart failure

Malhotra, Chetna; Bundoc, Filipinas; Ang, Felicia Jia Ler; Özdemir, Semra; Teo, Irene; Sim, David; Jaufeerally, Fazlur; Aung, Than Htike; Finkelstein, Eric A.

doi:10.1007/s11136-020-02736-7

Cited by 8 publications

(26 citation statements)

References 35 publications

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“…Moreover, previous studies reported that patients with HF who perceived difficulty in affording their medical care had lower perceived health status. 10,11,18 We extended prior findings by using a large national cohort. We demonstrated that PEB was associated with impaired health status, and the association was consistent during 1-year follow-up.…”

Section: Jama Network Open | Cardiologymentioning

confidence: 81%

“…They demonstrated that difficulty in affording medical care was associated with impaired quality of life, well-being, and mental health. [10][11][12] Nevertheless, these studies were limited by their small size. Additionally, a prior study found that financial barriers to health care services and medications were associated with increased rates of rehospitalization but not mortality after acute myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

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Perceived Economic Burden, Mortality, and Health Status in Patients With Heart Failure

Yu,

Liu,

Zhang

et al. 2024

JAMA Netw Open

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ImportanceIn the face of an emerging heart failure (HF) epidemic, describing the association between perceived economic burden (PEB) and health care outcomes is an important step toward more equitable and achievable care.ObjectivesTo examine the association between PEB and risk of 1-year clinical outcomes and HF–specific health status in patients with acute decompensated HF.Design, Setting, and ParticipantsThis prospective, multicenter, hospital-based cohort study prospectively enrolled adult patients hospitalized for acute decompensated HF at 52 hospitals in China from August 2016 to May 2018, with 1-year follow-up. Data were analyzed on June 17, 2022.ExposurePerceived economic burden, categorized as severe (cannot undertake expenses), moderate (can almost undertake expenses), or little (can easily undertake expenses).Main Outcomes and MeasuresThe clinical outcomes of the study were 1-year all-cause death and rehospitalization for HF. Heart failure–specific health status was assessed by the 12-Item Kansas City Cardiomyopathy Questionnaire (KCCQ-12).ResultsAmong 3386 patients, median age was 67 years (IQR, 58-75 years) and 2116 (62.5%) were men. Of these patients, 404 (11.9%) had severe PEB; 2021 (59.7%), moderate PEB; and 961 (28.4%), little PEB. Compared with patients with little PEB, those with severe PEB had increased risk of 1-year mortality (hazard ratio [HR], 1.61; 95% CI, 1.21-2.13; P &lt; .001) but not 1-year HF rehospitalization (HR, 1.21; 95% CI, 0.98-1.49; P = .07). The mean (SD) adjusted KCCQ-12 score was lowest in patients with severe PEB and highest in patients with little PEB at baseline (40.0 [1.7] and 50.2 [1.0] points, respectively; P &lt; .001) and at each visit (eg, 12 months: 61.5 [1.6] and 75.5 [0.9] points respectively; P &lt; .001). Patients reporting severe PEB had a clinically significant lower 1-year KCCQ-12 score compared with those reporting little PEB (mean difference, −11.3 points; 95% CI, −14.9 to −7.6 points; P &lt; .001).Conclusions and RelevanceIn this cohort study of patients with acute decompensated HF, greater PEB was associated with higher risk of mortality and poorer health status but not with risk of HF rehospitalization. The findings suggest that PEB may serve as a convenient tool for risk estimation and as a potential target for quality-improvement interventions for patients with HF.

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Section: Jama Network Open | Cardiologymentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Perceived Economic Burden, Mortality, and Health Status in Patients With Heart Failure

Yu,

Liu,

Zhang

et al. 2024

JAMA Netw Open

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“…Therefore, we take both hospital expenses and stays as a measure to assess the financial burden of inpatients with CHF. Financial burden was an important factor influencing the CHF patient's long-term compliance, which determined final prognosis ( 33 ). Previous studies have reported the impact of infection on the prognosis and severity of heart failure ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

Malnutrition and infection lead to poor prognosis and heavy financial burden of patients with chronic heart failure

Jia

et al. 2022

Front. Cardiovasc. Med.

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BackgroundChronic heart failure (CHF) is a major public health concern, as it is associated with poor prognosis and heavy financial burden. In recent years, there has been increasing interest in medications for CHF in China, but few studies pay attention to the effects of nutrition and infection.Methods and resultsThis was a retrospective study collected patients with CHF admitted to the Department of Cardiology of Qilu Hospital of Shandong University from January 2017 to May 2018. Patients were classified according to the prognosis and the financial burden. Through comparison and regression analysis, we found that the factor associated with worse prognosis were decreased heart rate, albumin and prealbumin; β-blockers and mineralocorticoid receptor antagonism (MRA) were the factor improved the prognosis of patients with CHF; the factor overburdening financial condition were infection, decreased prealbumin, high Alanine aminotransferase (ALT), usage of recombinant human brain natriuretic peptide (rhBNP) and Levosimendan; aspirin and Sacubitril/Valsartan were the factor releasing financial burden of patients with CHF. Then, we grouped by Controlling Nutritional Status (CONUT) score, which enabled evaluation of the patient's protein reserve and immune defenses. Patients in the malnutrition group had higher infection ratios, longer hospital stays, and greater hospital expenses than the normal group. The improvement ratios of therapeutic outcomes in the moderate or severe malnutrition group were lower than in the normal and mild malnutrition group.ConclusionMalnutrition and infection caused poor prognosis and increased financial burden of patients with CHF. The high CONUT score indicated the CHF patient's unfavorable prognosis and heavy financial burden.

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“…However, individuals have the option to enhance their health insurance coverage by purchasing private health insurance. 27…”

Section: Methodsmentioning

confidence: 99%

A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure

Ozdemir,

Lee,

Yeo

et al. 2023

Med Decis Making

Self Cite

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Objective Among patients with heart failure (HF), we examined 1) the evolution of patient involvement in decision making over 2 y, 2) the association of patient characteristics with decision-making roles, and 3) the association of decision-making roles with distress, spiritual well-being, and quality of physician communication. Methods We administered the survey every 4 mo over 24 mo to patients with New York Heart Association class 3/4 symptoms recruited from inpatient clinics. The decision-making roles were categorized as no patient involvement, physician/family-led, joint (with family and/or physicians), patient-led, or patient-alone decision making. The associations between patient characteristics and decision-making roles were assessed using a mixed-effects ordered logistic regression, whereas those between patient outcomes and decision-making roles were investigated using mixed-effects linear regressions. Results Of the 557 patients invited, 251 participated in the study. The most common roles in decision making at baseline assessment were “no involvement” (27.53%) and “patient-alone decision making” (25.10%). The proportions of different decision-making roles did not change over 2 y ( P = 0.37). Older age (odds ratio [OR] = 0.97; P = 0.003) and being married (OR = 0.63; P = 0.035) were associated with lower involvement in decision making. Chinese ethnicity (OR = 1.91; P = 0.003), higher education (OR = 1.87; P = 0.003), awareness of terminal condition (OR = 2.00; P < 0.001), and adequate self-care confidence (OR = 1.74; P < 0.001) were associated with greater involvement. Compared with no patient involvement, joint (β = −0.58; P = 0.026) and patient-led (β = −0.59; P = 0.014) decision making were associated with lower distress, while family/physician-led (β = 4.37; P = 0.001), joint (β = 3.86; P < 0.001), patient-led (β = 3.46; P < 0.001), and patient-alone (β = 3.99; P < 0.001) decision making were associated with better spiritual well-being. Conclusion A substantial proportion of patients was not involved in decision making. Patients should be encouraged to participate in decision making since it is associated with lower distress and better spiritual well-being. Highlights The level of involvement in medical decision making did not change over time among patients with heart failure. A substantial proportion of patients were not involved in decision making throughout the 24-mo study period. Patients’ involvement in decision making varied by age, ethnicity, education level, marital status, awareness of the terminal condition, and confidence in self-care. Compared with no patient involvement in decision making, joint and patient-led decision making were associated with lower distress, and any level of patient involvement in decision making was associated with better spiritual well-being.

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Financial difficulties and patient-reported outcomes among patients with advanced heart failure

Cited by 8 publications

References 35 publications

Perceived Economic Burden, Mortality, and Health Status in Patients With Heart Failure

Perceived Economic Burden, Mortality, and Health Status in Patients With Heart Failure

Malnutrition and infection lead to poor prognosis and heavy financial burden of patients with chronic heart failure

A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure

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