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When a person is suffering a heart attack, minutes matter. As cardiologists often say, Time is heart muscle. Acting fast on warning signs such as chest discomfort and shortness of breath saves lives and prevents damage to the heart muscle. So what would keep someone from calling 911 when they begin to experience symptoms typical of a heart attack? Concerns about money. According to a study published in the Journal of the American Medical Association, lack of health insurance or financial worries contribute to as much as a six-hour delay in seeking emergency treatment.
More than 1 million people have heart attacks each year in the U.S. Life-saving treatments to open the blocked artery and restore blood flow are most effective if started within one hour of the start of symptoms. Yet, the study shows that 49 percent of uninsured patients and 45 percent of insured patients with financial concerns delayed seeking care by more than six hours during a heart attack, compared with only 39 percent of insured patients without financial concerns.
Researchers used a registry of 3,721 participants enrolled in the Translational Research Investigating Underlying Disparities in Acute Myorcardial Infarction Patients Health Status (TRIUMPH) study at 24 U.S. hospitals. Nearly 40 percent were uninsured or were insured but reported financial concerns about accessing care. Whats also unique about the study is that researchers used patient interviews to determine affordability of medical care, rather than administrative data alone.
The results suggest that efforts to encourage patients to seek life-saving care in a prompt manner may have limited impact without first ensuring that access to health insurance is improved and financial concerns are addressed among patients who seek emergency care, says first author Kim Smolderen, Ph.D., of the Center of Research on Psychology in Somatic Diseases at Tilburg University, Tilburg the Netherlands. The inability to address patients cost concerns may, in part, explain the failure of previous efforts to reduce pre-hospital delays during heart attack, says Brahmajee K. Nallamothu, M.D., M.P.H., cardiologist at the University of Michigan Cardiovascular Center and associate professor of internal medicine at the U-M Medical School. Because black patients and female patients are more likely to have financial concerns about medical costs despite having insurance coverage or be uninsured, improving health coverage has the potential to reduce racial and gender disparities in heart attack care, according to the study. Authors say that its likely that uninsured patients and insured patients with financial concerns about accessing care not only would delay seeking care for heart attacks, but would also delay care for other common conditions such as stroke, pneumonia and appendicitis. Ultimately, efforts to reduce pre-hospital delays for heart attacks and other emergency conditions may have limited benefit unless U.S. health care insurance coverage is extended and the affordability of care among those with insurance isBicycling Matte Releaseimproved, Chan says.