Rahimi Ali R, Spertus John A, Reid Kimberly J, Bernheim Susannah M, Krumholz Harlan M
Department of Medicine,Yale University School of Medicine, New Haven, Conn 06520-8088, USA.
JAMA. 2007 Mar 14;297(10):1063-72. doi: 10.1001/jama.297.10.1063.
The prevalence and consequences of financial barriers to health care services and medications are not well documented for patients with an acute myocardial infarction (AMI).
To measure the baseline prevalence of self-reported financial barriers to health care services or medication (as defined by avoidance due to cost) among individuals following AMI and their association with subsequent health care outcomes.
DESIGN, SETTING, AND PARTICIPANTS: The Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, multicenter US study of patients with AMI over 12 months in 2498 individuals enrolled from January 2003 through June 2004.
Health status symptoms (Seattle Angina Questionnaire [SAQ]), overall health status function (Short Form-12), and rehospitalization.
The prevalence of self-reported financial barriers to health care services or medication was 18.1% and 12.9%, respectively. Among individuals who reported financial barriers to health care services or medication, 68.9% and 68.5%, respectively, were insured. At 1-year follow-up, individuals with financial barriers to health care services were more likely to have lower SAQ quality-of-life score (77.9 vs 86.2; adjusted mean difference= -4.0; 95% confidence interval [CI], -6.3 to -1.8), and increased rates of all-cause rehospitalization (49.3% vs 38.1%; adjusted hazard ratio [HR], 1.3; 95% CI, 1.1-1.5) and cardiac rehospitalization (25.7% vs 17.7%; adjusted HR, 1.3; 95% CI, 1.0-1.6). At 1-year follow-up, individuals with financial barriers to medication were more likely to have angina (34.9% vs 17.9%; adjusted odds ratio, 1.55; 95% CI, 1.1-2.2), lower SAQ quality-of-life score (74.0 vs 86.1; adjusted mean difference = -7.6; 95% CI, -10.2 to -4.9), and increased rates of all-cause rehospitalization (57.0% vs 37.8%; risk-adjusted HR, 1.5; 95% CI, 1.2-1.8) and cardiac rehospitalization (33.7% vs 17.3%; adjusted HR, 1.7; 95% CI, 1.3-2.2).
Financial barriers to health care services and medications are associated with worse recovery after AMI, manifested as more angina, poorer quality of life, and higher risk of rehospitalization.
急性心肌梗死（AMI）患者面临的医疗服务和药物治疗经济障碍的患病率及后果尚无充分记录。
测量AMI患者自我报告的医疗服务或药物治疗经济障碍（定义为因费用而避免治疗）的基线患病率及其与后续医疗结局的关联。
设计、设置和参与者：前瞻性心肌梗死评估登记：事件与恢复（PREMIER），这是一项在美国进行的观察性多中心研究，于2003年1月至2004年6月招募了2498例AMI患者，随访12个月。
健康状况症状（西雅图心绞痛问卷[SAQ]）、总体健康状况功能（简明健康状况调查简表-12）和再次住院情况。
自我报告的医疗服务或药物治疗经济障碍的患病率分别为18.1%和12.9%。在报告有医疗服务或药物治疗经济障碍的个体中，分别有68.9%和68.5%拥有保险。在1年随访时，有医疗服务经济障碍的个体更有可能SAQ生活质量得分较低（77.9对86.2；调整后平均差异=-4.0；95%置信区间[CI]，-6.3至-1.8），全因再次住院率增加（49.3%对38.1%；调整后风险比[HR]，1.3；95%CI，1.1-1.5）以及心脏相关再次住院率增加（25.7%对17.7%；调整后HR，1.3；95%CI，1.0-1.6）。在1年随访时，有药物治疗经济障碍的个体更有可能发生心绞痛（34.9%对17.9%；调整后优势比，1.55；95%CI，1.1-2.2），SAQ生活质量得分较低（74.0对86.1；调整后平均差异=-7.6；95%CI，-10.2至-4.9），全因再次住院率增加（57.0%对37.8%；风险调整后HR，1.5；95%CI，1.2-1.8）以及心脏相关再次住院率增加（33.7%对17.3%；调整后HR，1.7；95%CI，1.3-2.2）。
医疗服务和药物治疗的经济障碍与AMI后恢复较差相关，表现为心绞痛更多、生活质量更差以及再次住院风险更高。
