Financial Stress and Outcomes after Acute Myocardial InfarctionReportar como inadecuado

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Little is known about the association between financial stress and health care outcomes. Our objective was to examine the association between self-reported financial stress during initial hospitalization and long-term outcomes after acute myocardial infarction AMI.

Materials and Methods

We used Prospective Registry Evaluating Myocardial Infarction: Event and Recovery PREMIER data, an observational, multicenter US study of AMI patients discharged between January 2003 and June 2004. Primary outcomes were disease-specific and generic health status outcomes at 1 year symptoms, function, and quality of life QoL, assessed by the Seattle Angina Questionnaire SAQ and Short Form SF-12. Secondary outcomes included 1-year rehospitalization and 4-year mortality. Hierarchical regression models accounted for patient socio-demographic, clinical, and quality of care characteristics, and access and barriers to care.


Among 2344 AMI patients, 1241 52.9% reported no financial stress, 735 31.4% reported low financial stress, and 368 15.7% reported high financial stress. When comparing individuals reporting low financial stress to no financial stress, there were no significant differences in post-AMI outcomes. In contrast, individuals reporting high financial stress were more likely to have worse physical health SF-12 PCS mean difference −3.24, 95% Confidence Interval CI: −4.82, −1.66, mental health SF-12 MCS mean difference: −2.44, 95% CI: −3.83, −1.05, disease-specific QoL SAQ QoL mean difference: −6.99, 95% CI: −9.59, −4.40, and be experiencing angina SAQ Angina Relative Risk = 1.66, 95%CI: 1.19, 2.32 at 1 year post-AMI. While 1-year readmission rates were increased Hazard Ratio = 1.50; 95%CI: 1.20, 1.86, 4-year mortality was no different.


High financial stress is common and an important risk factor for worse long-term outcomes post-AMI, independent of access and barriers to care.

Autor: Sachin J. Shah, Harlan M. Krumholz, Kimberly J. Reid, Saif S. Rathore, Aditya Mandawat, John A. Spertus, Joseph S. Ross



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