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Does financial hardship associate with abnormal quantitative myocardial perfusion and major adverse cardiovascular event?

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Data on impact of financial hardship on coronary artery disease (CAD) remain incomplete.

Methods

Consecutive subjects referred for clinical rest/stress cardiac positron emission tomography (PET) were enrolled. Financial hardship is defined as patients’ inability to pay for their out-of-pocket expense for cardiac PET. Abnormal cardiac PET is defined as at least moderate relative perfusion defects at stress involving > 10% of the left ventricle or global coronary flow reserve ≤ 2.0. Patients were followed for major adverse cardiovascular event (MACE) comprised of all-cause mortality, non-fatal myocardial infarction, and late coronary revascularization.

Results

We analyzed a total of 4173 patients with mean age 65.6 ± 11.3 years, 72.2% men, and 93.6% reported as having medical insurance. Of these, 504 (12.1%) patients had financial hardship. On multivariable analysis, financial hardship associated with abnormal cardiac PET (odds ratio 1.377, p = 0.004) and MACE (hazard ratio 1.432, p = 0.010) and its association with MACE was mostly through direct effect with small proportion mediated by abnormal cardiac PET or known CAD.

Conclusion

Among patients referred for cardiac rest/stress PET, financial hardship independently associates with myocardial perfusion abnormalities and MACE; however, its effect on MACE is largely not mediated by abnormal myocardial perfusion or known CAD suggesting distinct impact of financial hardship beyond traditional risk factors and CAD that deserves attention and intervention to effectively reduced adverse outcomes. Having medical insurance does not consistently protect from financial hardship and a more preventive-oriented restructuring may provide better outcomes at lower cost.

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Abbreviations

PET:

Positron emission tomography

DCI:

Distress Community Index

CT:

Computed tomography

CFR:

Coronary flow reserve

CAD:

Coronary artery disease

OR:

Odds ratio

CI:

Confidence interval

HR:

Hazard ratio

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Authors and Affiliations

  1. Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA

    Danai Kitkungvan MD, Nils P. Johnson MD, MS, Linh Bui MD, Monica B. Patel MD, Richard Kirkeeide PhD & K. Lance Gould MD

  2. Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA

    Danai Kitkungvan MD, Nils P. Johnson MD, MS, Linh Bui MD, Monica B. Patel MD, Amanda E. Roby CNMT, RT(N), Mary Haynie RN, MBA, Richard Kirkeeide PhD, Susan Hood & K. Lance Gould MD

Authors
  1. Danai Kitkungvan MD
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  2. Nils P. Johnson MD, MS
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  3. Linh Bui MD
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  4. Monica B. Patel MD
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  5. Amanda E. Roby CNMT, RT(N)
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  9. K. Lance Gould MD
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Corresponding author

Correspondence to K. Lance Gould MD.

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Disclosures

Danai Kitkungvan, Nils P. Johnson, Linh Bui, Monica B. Patel, Amanda E. Roby, Mary Haynie, Richard Kirkeeide, Susan Hood, and K. Lance Gould declare that they have no conflict of interest.

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Funding

Research supported by internal funds of the Weatherhead PET Center No authors have a relationship with industry related to this manuscript. NPJ received internal funding from Weatherhead PET Center for Preventing and Reversing Atherosclerosis and research support from St. Jude Medical (for NCT02184117) and Volcano/Philips Corporation (for NCT02328820). KLG received internal funding from the Weatherhead PET Center and is the applicant for 510(k) FDA cleared HeartSee K171303 PET software. To avoid any conflict of interest, KLG assigned any royalties arising from PET software to UT for research or student scholarships.

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Kitkungvan, D., Johnson, N.P., Bui, L. et al. Does financial hardship associate with abnormal quantitative myocardial perfusion and major adverse cardiovascular event?. J. Nucl. Cardiol. 30, 1528–1539 (2023). https://doi.org/10.1007/s12350-022-03184-1

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