Effect of difficulty affording health care on health status after coronary revascularization

Abstract

Background - An objective of the United States' Healthy People 2010 Initiative is to eliminate disparities based on socioeconomic status. We assessed the effect of difficulty affording health care on the health status (symptoms, function, and quality of life) of patients treated with percutaneous coronary intervention or CABG. Methods and Results - A consecutive, single-center cohort of 480 patients undergoing coronary revascularization received the Seattle Angina Questionnaire at the time of their procedure and at subsequent monthly intervals for 6 months. At baseline, patients who reported somewhat of a burden to a severe burden in affording health care had significantly lower scores on the Seattle Angina Questionnaire (mean±SD) with respect to angina (55±29 versus 68plusmn;25, P<0.0001), physical limitation (55plusmn;26 versus72plusmn;24. P<0.0001), and quality of life (46plusmn;22 versus 56plusmn;22, P<0.0001) than those who did not perceive healthcare costs to be burdensome. Although both groups of patients improved after revascularization, poorer health status persisted among those with difficulty affording health care after percutaneous coronary intervention (6-month meanplusmn;SE: angina 79plusmn;2.5 versus 88plusmn;1.9, P=0.002; physical function 61plusmn;2.7 versus 80plusmn;2.0, P<0.0001; quality of life 67plusmn;2.4 versus 82plusmn;1.8, P<0.0001) but not after CABG (angina 91plusmn;2.5 versus 93plusmn;1.6, P=0.47; physical function 75plusmn;3.4 versus 81plusmn;2.2, P=0.13; quality of life 84plusmn;3.1 versus 84plusmn;2.0, P=0.81). Similar differences remained after adjustment for demographic and clinical characteristics. Conclusions - Patients reporting difficulty affording health care have worse health status at the time of coronary revascularization. A persistent disparity exists after percutaneous but not surgical revascularization. Additional inquiry into the mechanism of this disparity is needed so that the goals of equitable health care, irrespective of treatment strategy, can be achieved. © 2005 American Heart Association, Inc.