Older adults with severe financial strain 61% more likely to die after acute MI
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Older adults with severe financial strain had a greater risk for mortality 6 months after being discharged from the hospital for an acute myocardial infarction than those without financial strain, according to recent data.
The findings were published in JAMA Internal Medicine.
“Many financially strained older adults have skipped medications or avoided health care because of cost-related barriers,” Jason R. Falvey, PT, DPT, PhD, an assistant professor in physical therapy and rehabilitation science at the University of Maryland School of Medicine, told Healio. “Primary care physicians are ideally positioned to identify financially strained older adults, and with timely referral for community services and supports, could help mitigate the negative health consequences of financial strain on post-acute myocardial infarction (MI) outcomes.”
Falvey and colleagues conducted a geographically diverse, longitudinal cohort study of 2,851 adults in the U.S. aged 75 years or older who were hospitalized sometime between January 2013 to June 2017 after an acute MI. They compared mortality rates among those with no financial strain, moderate financial strain and severe financial strain in the 180 days after discharge.
Among those with no self-reported financial strain, the mean age was 81.6 years; 60% were men and 7% were not white. Those with moderate financial strain were aged 81.4 years on average; 49% were men and 17% were not white. Individuals reporting severe financial strain were aged 80 years on average; 43% were men and 19% were not white.
Overall, 7.2% of participants with no financial strain died during the follow-up period compared with 9.2% of those with moderate financial strain and 16.8% of those with severe financial strain.
Falvey and colleagues reported that severe financial strain was associated with a 61% increase in 180-day mortality risk (HR = 1.61; 95% CI, 1.07-2.41) compared with adults with no strain. There was no significant association between moderate financial strain and an increased risk for mortality (HR = 1.04; 95% CI, 0.78-1.39). The results were comparable when adjusting for sex among those with severe strain (HR = 1.6; 95% CI, 1.07-2.41) and those with moderate strain (HR = 1.04; 95% CI, 0.78-1.39), according to the researchers.
A single screening question about financial strain was able to identify high-risk cohorts. It is “highly feasible” to adopt screening for financial strain into an EHR for risk stratification, according to Falvey.
“Financial strain for older adults is a growing concern, and patient-level interventions are necessary but probably insufficient to ameliorate the downstream consequences,” he said. “Larger policy interventions, like increasing affordable housing and addressing transportation barriers for older adults, are likely needed to reduce socioeconomic inequities in care outcomes after [acute] MI.”