Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population

Alexander Thomas, Javier Valero-Elizondo, Rohan Khera, Haider J. Warraich, Samuel W. Reinhardt, Hyeon Ju Ali, Khurram Nasir, Nihar R. Desai

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


OBJECTIVES: The objective of this study was to describe the prevalence of patients with forgone/delayed care for heart failure (HF) and examine the associated demographic characteristics, health care utilization, and costs.

BACKGROUND: HF is a leading cause of morbidity and mortality, with health care expenditures projected to increase 3-fold from 2012 to 2030. The proportion of HF patients with forgone/delayed medical care and the association with health care expenditures and utilization remain unknown.

METHODS: Data on patients with HF were obtained from the Medical Expenditure Panel Survey to assess expenditures and health care utilization in the United States from 2004 to 2015. Patients with HF who reported forgone/delayed care, any missed or delayed medical treatment, were compared with those without care lapses.

RESULTS: Overall, 16% of patients with HF reported forgone/delayed care, including 10% among the elderly (aged ≥65 years) and 27% among the nonelderly (aged <65 years). Patients with HF who reported forgone/delayed care had annual health care expenses $8,027 (95% CI: $1,181-$14,872) higher than those who did not. Among the elderly, those reporting forgone/delayed care had more emergency department visits (43% vs 58%; P < 0.05), and had higher annual inpatient costs (+$7,548; 95% CI: $1,109-$13,988) and total health care costs (+$10,581; 95% CI: $1,754-$19,409). Sixty percent of nonelderly and 46% of elderly patients with HF reported deferring care due to financial barriers.

CONCLUSIONS: Nearly 1 in 6 patients with HF in the United States reported forgone/delayed medical care, with one-half attributing it to financial reasons, and this was associated with higher overall health care spending.

Original languageEnglish (US)
Pages (from-to)710-719
Number of pages10
JournalJACC: Heart Failure
Issue number10
StatePublished - Oct 2021


  • elderly
  • forgone care
  • health economics
  • heart failure
  • outcomes
  • patient care
  • Heart Failure/epidemiology
  • Emergency Service, Hospital
  • Prevalence
  • Humans
  • Health Expenditures
  • Health Care Costs
  • United States/epidemiology
  • Aged

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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