Elsevier

JACC: Heart Failure

Volume 9, Issue 10, October 2021, Pages 710-719
JACC: Heart Failure

Clinical Research
Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population

https://doi.org/10.1016/j.jchf.2021.05.010Get rights and content
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Abstract

Objectives

The objective of this study was to describe the prevalence of patients with forgone/delayed care for heart failure (HF) and examine the associated demographic characteristics, health care utilization, and costs.

Background

HF is a leading cause of morbidity and mortality, with health care expenditures projected to increase 3-fold from 2012 to 2030. The proportion of HF patients with forgone/delayed medical care and the association with health care expenditures and utilization remain unknown.

Methods

Data on patients with HF were obtained from the Medical Expenditure Panel Survey to assess expenditures and health care utilization in the United States from 2004 to 2015. Patients with HF who reported forgone/delayed care, any missed or delayed medical treatment, were compared with those without care lapses.

Results

Overall, 16% of patients with HF reported forgone/delayed care, including 10% among the elderly (aged ≥65 years) and 27% among the nonelderly (aged <65 years). Patients with HF who reported forgone/delayed care had annual health care expenses $8,027 (95% CI: $1,181-$14,872) higher than those who did not. Among the elderly, those reporting forgone/delayed care had more emergency department visits (43% vs 58%; P < 0.05), and had higher annual inpatient costs (+$7,548; 95% CI: $1,109-$13,988) and total health care costs (+$10,581; 95% CI: $1,754-$19,409). Sixty percent of nonelderly and 46% of elderly patients with HF reported deferring care due to financial barriers.

Conclusions

Nearly 1 in 6 patients with HF in the United States reported forgone/delayed medical care, with one-half attributing it to financial reasons, and this was associated with higher overall health care spending.

Key Words

elderly
forgone care
health economics
heart failure
outcomes
patient care

Abbreviations and Acronyms

CRF
cardiovascular modifiable risk factor
ED
emergency department
HF
heart failure
ICD-9-CM
International Classification of Diseases-9th Edition-Clinical Modification
MEPS
Medical Expenditure Panel Survey
OOP
out-of-pocket

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