People who are uninsured (or do not have medical aid) or have concerns about the cost of medical care are more likely to postpone seeking emergency care for a heart attack, researchers have found.
For many people, these factors lead to delays in seeking care of six hours or more from the onset of symptoms, according to the new findings.
The study, reported in the Journal of the American Medical Association, shows that, even among people with private health insurance, money worries are associated with delays in getting to the hospital for treatment.
"We've identified something that potentially could be a big player in shaping how patients come to the hospitals, not only for heart attack but potentially for other emergencies," said Dr. Paul S. Chan, the study's senior author and a cardiologist with Mid America Heart Institute at St. Luke's Health System in Kansas City, Mo.
Whether people have insurance and the type of coverage they have are potentially modifiable, Chan explained, whereas factors previously linked to delays in heart attack care -- such as being black or female -- are not.
National health-reform legislation will expand access to coverage, experts say, but it's no panacea for Americans' concerns about paying their share of the health-care tab, including deductibles and co-insurance for hospital admissions.
Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas and president of the American Heart Association, described the study findings as striking.
"What it means is that the critical window when we can intervene most successfully is closed when those patients present for heart attack care -- meaning they have more consequences, meaning that, ironically, they have more health-care need," Yancy said.
Dr. Angela F. Gardner, an assistant professor of emergency medicine at the University of Texas Southwestern Medical Centre in Dallas and president of the American College of Emergency Physicians, said the findings ring true with what physicians experience in everyday practice.
"I think that people do delay care based on fears of the financial repercussions of it," she said, describing incidents in which people report having symptoms long before going to see a physician or refuse ambulance transportation because of cost concerns.
How the study was done
For the study, lead author Kim G. Smolderen of Tilburg University in the Netherlands and her fellow researchers in the United States examined data from a registry of 3 721 people who had heart attacks and were admitted to one of 24 US hospitals between April 11, 2005 and Dec. 31, 2008.
Using information from medical records to determine insurance status and interviews to assess financial concerns, researchers classified people one of three ways: insured without financial concerns, insured but with financial concerns about accessing care, or uninsured.
Nearly two-fifths of the people in the study were either uninsured (19.8%) or had financial concerns about accessing care (18.5%), the researchers found.
Among those with insurance who had financial concerns, 82.8% said they avoided medical care, 55.6% avoided taking medications and 12.8% reported having trouble obtaining health-care services because of costs.
Delays in arriving at the hospital of six or more hours were more prevalent among the uninsured (48.6%^) and people who were insured but also had money worries (44.6%) than among the insured who had no financial concerns (39.3%).
Likewise, a greater proportion of insured patients without money worries (36.6%) arrived at the hospital within two hours of symptom onset than did the insured with financial concerns (33.5%) and uninsured patients (27.5%).
The paper underscores the "handicap" that the uninsured and underinsured have, Yancy noted, "but it also highlights the impediment that even the insured have in accessing health care."
The message to patients? Hours and minutes can make a difference between life and death, so don't delay seeking emergency care.
"If you are concerned that you're having a heart attack or a stroke, you should call the hospital," Gardner said. "The barrier of money should not stop a patient from being cared for if they have an emergency condition." - (HealthDay News, April 2010)