title: Financial stress and outcomes after acute myocardial infarction.
abstract: BACKGROUND
  Little is known about the association between financial stress and health care outcomes. Our objective was to examine the association between self-reported financial stress during initial hospitalization and long-term outcomes after acute myocardial infarction (AMI).
  
  
  METHODS
  We used prospective registry evaluating myocardial infarction: Event and Recovery (PREMIER) data, an observational, multicenter US study of AMI patients discharged between January 2003 and June 2004. Primary outcomes were disease-specific and generic health status outcomes at 1 year (symptoms, function, and quality of life (QoL)), assessed by the Seattle Angina Questionnaire [SAQ] and Short Form [SF]-12. Secondary outcomes included 1-year rehospitalization and 4-year mortality. Hierarchical regression models accounted for patient socio-demographic, clinical, and quality of care characteristics, and access and barriers to care.
  
  
  RESULTS
  Among 2344 AMI patients, 1241 (52.9%) reported no financial stress, 735 (31.4%) reported low financial stress, and 368 (15.7%) reported high financial stress. When comparing individuals reporting low financial stress to no financial stress, there were no significant differences in post-AMI outcomes. In contrast, individuals reporting high financial stress were more likely to have worse physical health (SF-12 PCS mean difference -3.24, 95% Confidence Interval [CI]: -4.82, -1.66), mental health (SF-12 MCS mean difference: -2.44, 95% CI: -3.83, -1.05), disease-specific QoL (SAQ QoL mean difference: -6.99, 95% CI: -9.59, -4.40), and be experiencing angina (SAQ Angina Relative Risk = 1.66, 95%CI: 1.19, 2.32) at 1 year post-AMI. While 1-year readmission rates were increased (Hazard Ratio = 1.50; 95%CI: 1.20, 1.86), 4-year mortality was no different.
  
  
  CONCLUSIONS
  High financial stress is common and an important risk factor for worse long-term outcomes post-AMI, independent of access and barriers to care.
authors.affiliation: Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors.forename: Sachin J
authors.initials: SJ
authors.lastname: Shah
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Saif S
authors.initials: SS
authors.lastname: Rathore
authors.forename: Aditya
authors.initials: A
authors.lastname: Mandawat
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome