Financial burden of survivors of medically-managed myocardial infarction and its association with selected social determinants and quality of life in a lower middle income country

Abstract

Background

Burden from ischemic heart disease is rising in Sri Lanka due to the demographic and epidemiological transitions . Documented literature is scarce on quality of life, financial burden and its determinants in relation to myocardial infarction (MI). This study was done to describe the financial burden among the survivors of MI managed only with drugs (i.e. those who did not undergo Percutaneous Coronary Intervention or Coronary Artery Bypass Graft) and its association with selected social determinants (SDHs) and quality of life (QOL).

Methods

A cross sectional study was done among MI survivors in 13 hospitals in the premier province of Sri Lanka. Out of 336 participants recruited at hospital stay, 270 responded through a self-administered questionnaire at 1 month post discharge. Questionnaire included sections on financial burden, selected SDHs and on QOL measured by the EQ-5D-3 L QOL tool. Presence of financial burden was determined using an operational definition. Associations were tested with Mann–Whitney-U test, Chi square test and Spearman-correlation-coefficient at 5% significant level.

Results

Around 40% ( n = 116) had to seek financial support for out-of-pocket expenditure. Nearly 5% ( n = 6) of previously employed participants had lost their job. Of the employed respondents ( n = 139, 51.5%) , 29% ( n = 85) had limited physical activity and 40% ( n = 115) had limitations of employment time. Of the respondents, 15.4% had to apply for a loan, 7.8% had to sell a property, 19.1% had an income loss and 33.8% had to restrict usual expenses. Financial burden was not significantly associated with gender ( p = 0.146), ethnicity ( p = 0.068), highest education ( p = 0.184) and area of residence ( p = 0.369). Influence of income ( p = 0.001), social support ( p = 0.002) and the health infrastructure ( p < 0.001) were significantly associated with the occurrence of a financial burden. In the group with a financial burden, the index score (p = 0.002) and VAS score (p < 0.001) of EQ-5D-3 L were significantly lower.

Conclusions

Financial burden is common among survivors of medically-managed occurring irrespective of the gender, ethnicity, education and the area. It is influenced significantly by the income, level of social support and the level of health infrastructure. The financial burden is influencing the post-discharge-1-month QOL.