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(Circulation. 2005;111:2572-2578.)
© 2005 American Heart Association, Inc.

Health Services and Outcomes Research

Effect of Difficulty Affording Health Care on Health Status After Coronary Revascularization

John Spertus, MD, MPH; Carole Decker, PhD; Catherine Woodman, MD; John House, MS; Phil Jones, MS; James O’Keefe, MD; A. Michael Borkon, MD

From the Mid America Heart Institute of Saint Luke’s Hospital (J.S., C.D., J.H., P.J., J.O., A.M.B.), University of Missouri–Kansas City (J.S., C.D., J.O., A.M.B.), Kansas City, Mo; and the University of Iowa (C.W.), Iowa City, Iowa.

Correspondence to John Spertus, MD, MPH, FACC, Director of Cardiovascular Education and Outcomes Research, Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail spertusj{at}umkc.edu

Received May 12, 2004; revision received January 22, 2005; accepted February 10, 2005.

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 68±25, P<0.0001), physical limitation (55±26 versus72±24, P<0.0001), and quality of life (46±22 versus 56±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 mean±SE: angina 79±2.5 versus 88±1.9, P=0.002; physical function 61±2.7 versus 80±2.0, P<0.0001; quality of life 67±2.4 versus 82±1.8, P<0.0001) but not after CABG (angina 91±2.5 versus 93±1.6, P=0.47; physical function 75±3.4 versus 81±2.2, P=0.13; quality of life 84±3.1 versus 84±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.

Key Words: prognosis • angioplasty • bypass • angina • revascularization

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