Forgoing, Delaying Care Linked to Increased Health Spending in the Future in Heart Failure

A recent analysis of Medical Expenditure Survey data is painting a grim picture related to the proportion of patients with heart failure who have forgone or delayed care and the financial burden it can cause on these patients moving forward.

Results of the analysis suggest more than 15% of patients with heart failure reported forgoing or delaying care, with half citing financial burden as the primary reason. The Yale University School of Medicine-led team who conducted the study also pointed delaying care was associated with significant increases in health care spending and this was most apparent among elderly patients.

“This study is the first to describe the association between forgone/delayed care in the US HF population and health care use or costs. Patients with HF were more likely to report forgone/delayed medical care compared with the general population,” wrote investigators. “Within the overall HF population, those reporting forgone/ delayed medical care had more than $8,000 higher medical expenditure per year than those not reporting forgone/delayed care.”

Although proper uptake of guideline-directed medical therapies is a struggle in the management of many conditions, cost is among the most common reasons cited for delayed or forgoing care among patients with heart failure. As noted by investigators, forgoing or delaying care has been linked to increased health care costs. The current study was designed by investigators to better understand how this phenomenon affects patients with heart failure, specifically among older patients.

With this in mind, investigators designed their study as an analysis of the data from Medical Expenditure Panel Survey from 2004-2015. Using this data, investigates planned to compare expenditures and health care utilization among patients with heart failure who reported forgoing or delaying care against those with no reported lapses in care.

Among the 259,594 individuals surveyed from 2004-2015, 2050 had a diagnosis of heart failure. In comparison to those without heart failure, patients with heart failure were older, less educated, more likely to be insured, and have a poor cardiovascular risk profile. Among patients with heart failure, 16% reported having forgone or delayed medical care, including 10% of patients aged 65 years or older and 27% among those less than 65 years of age.

Of those who reported forgoing or delaying medical care, 60.5% were nonelderly (P <.001), 55.2% were from low-income families (P=.004), and 59.3% had a poor cardiovascular risk factors profile (P <.001). The most common reason for forgoing or delaying care was financial barriers, which was cited as the primary reason among 55% all patients. Investigators also noted cost was cited as the primary reason among 60% of nonelderly patients and 46% of elderly patients.

When comparing annual health care expenses, those who reported forgone/delayed care had annual expenses $8027 than those who did not. Among elderly patients, those reporting forgone/delayed care were more likely to have an emergency department visit (43% vs 58%; P <.05) and have higher annual inpatient costs ($7548; 95% CI, 1109-13,988) and total health care costs ($10,581; 95% CI, 1754-19,409) than those who did not report forgoing or delaying care.

This study, “Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population,” was published in JACC: Heart Failure.