Severe Financial Strain Linked to Death After Acute Myocardial Infarction

Jason R. Falvey, PT, DPT, PhD

Severe financial strain was associated with higher risk of death in older adults hospitalized after an acute myocardial infarction (AMI) within the 6 months following discharge, new data suggests.

Although severe financial strain among older adults has been associated with lower medication adherence, which may negatively affect recovery, there have been no evaluations of that relationship for AMI outcomes.

Study author Jason R. Falvey, PT, DPT, PhD, Departments of Physical Therapy and Rehabilitation Science and Epidemiology and Public Health, University of Maryland School of Medicine, and a team of investigators noted the risk continued after accounting for medical complexity, functional impairments, and conditions of aging.

“While a limitation of the study is the potential for confounding by unmeasured illness severity, the magnitude of the mortality difference suggests assessment of financial strain may identify a unique subset of older adults at elevated risk following an AMI,” Falvey wrote.

Data was collected from the SILVER-AMI, a prospective longitudinal cohort study of older US adults (≥75 years). Participants self-reported financial strain during AMI admission, categorized in admission with prior work:

• None; patients reported they had more than enough money to make ends meet each month
• Moderate; just enough to make ends meet each month
• Severe; not enough to make ends meet

The primary outcome was considered time to death in the 180 days following discharge. From the 3041 participants in the SILVER-AMI cohort, investigators included those discharged alive (n = 3006) with complete data on financial strain (n = 2851) and evaluated adjusted risk using Cox proportional hazards model with follow-up censored at 180 days.

Patient-reported financials at the end of each month showed 1864 patients had more than enough to make ends meet, 796 had just enough to make ends meet, and 191 patients did not have enough to make ends meet.

Data show financially strained older adults had higher rates of chronic disease and geriatric vulnerability, compared to those with no strain. At 180 days of discharge, 134 of 1864 (7.2%) older adults with no financial strain died, compared to 74 of 796 (9.2%) of those with moderate strain and 32 of 191 (16.8%) of those reporting severe financial strain.

Following adjustment, investigators observed severe financial strain was associated with a 61% increase in 180-day mortality risk (hazard ratio [HR], 1.61; 95% CI, 1.07 - 2.41) in comparison to those with no strain. However, moderate financial strain was not associated with mortality (HR, 1.04; 95% CI, 0.78 - 1.39)

Adjustments for sex showed comparable results among those with severe strain (HR, 1.60; 95% CI, 1.07 - 2.41) and those with moderate strain (HR, 1.04; 95% CI, 0.78 - 1.39).

As such, screening for financial strain at admission may provide an opportunity for clinicians to “probe for resource needs in an actionable way.”

“These interventions likely need to be paired with state and local-level policy changes (eg, housing supports) to maximally improve outcomes for financially strained older adults recovering from an AMI,” Falvey concluded.

The research letter, “Association of Financial Strain With Mortality Among Older US Adults Recovering From an Acute Myocardial Infarction,” was published in JAMA Internal Medicine.