Financial Toxicity of Acute Cardiovascular Disease in India: A Dive Beyond the Tip of an Iceberg | Acute Coronary Syndromes | JAMA Network Open | JAMA Network
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Invited Commentary
Global Health
May 17, 2019

Financial Toxicity of Acute Cardiovascular Disease in India: A Dive Beyond the Tip of an Iceberg

Author Affiliations
  • 1Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
  • 2Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 3Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas
JAMA Netw Open. 2019;2(5):e193839. doi:10.1001/jamanetworkopen.2019.3839

The developing world has experienced an unprecedented epidemiologic transition with an accelerating epidemic of noncommunicable diseases.1 Among these, the rising burden of cardiovascular disease has met poorly equipped health systems to create a perfect storm. Not only has cardiovascular disease become the leading cause of morbidity and mortality in the developing world,1 its meteoric rise poses an extraordinary financial risk to patients, their families, and the overburdened health systems. However, despite this threat, the financial implications of cardiovascular disease, particularly of unanticipated major cardiovascular events, remain poorly understood in the developing world.

Mohanan and colleagues2 shed light on the financial outcomes of patients in the 30 days following a hospitalization for acute myocardial infarction (AMI) in a cohort of patients with AMI in the Indian state of Kerala. More than half (56%) of the 2114 participants in the study reported a health care expenditure that exceeded 40% of the annual postsubsistence income, that is, income after food-related expenses. Expenses beyond this threshold can potentially lead to financial ruin and are therefore categorized as catastrophic health expenses.3 Notably, more than 90% of costs were secondary to short-term inpatient care. One in 10 individuals even reported coping with these expenses through loans. Although the study was limited by its focus on a selected patient population and self-reported income and expenses, the magnitude of financial hardship identified in this study advances our understanding of the unmistakable financial adversity posed by acute cardiovascular disease.

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