Uninsured wait longer to seek treatment for heart attacks, study finds

KANSAS CITY, Mo. — There’s the pressure in the chest, the pain radiating through arms and shoulders, the queasiness, sweating, shortness of breath.

Warning signs of a heart attack should be hard to ignore. But that’s just what many people try to do if they have little or no health insurance, a new study finds.

Uninsured people — and even people who have insurance but have trouble paying medical bills — wait significantly longer to go to a hospital for heart attacks than insured people who don’t have major financial concerns about their health care.

“Even for those with the security blanket of insurance, it wasn’t always enough,” said researcher Paul Chan, a heart specialist at St. Luke’s Hospital in Kansas City, Mo. “They knew they could get care, but there was no guarantee they could afford it. You can just imagine what it was like for the uninsured.”

Or you can ask patients such as Larry Scott, who waited weeks after his symptoms appeared before seeing a doctor.

“I was more worried about creating a medical bill than about my health,” Scott said.

His heart is now permanently damaged.

In a study being published Wednesday in the Journal of the American Medical Association, Chan, St. Luke’s heart specialist John Spertus and researchers at Yale New Haven Hospital, the Mayo Clinic and several other medical centers looked at data on 3,721 patients from across the country who had survived heart attacks. The patients went to 24 hospitals from 2005 through 2008.

The researchers found that 48.6 percent of uninsured patients waited more than six hours after their symptoms started to get to a hospital. That compared to 39.3 percent of patients who were insured and did not have significant problems paying for care.

And among insured patients who had financial concerns about getting health care, 44.6 percent waited more than six hours. After about six hours, emergency heart attack treatments become less effective.

Previous studies have found that uninsured patients are less likely than the insured to get checkups or preventive care. They are more likely to end up in the hospital with avoidable conditions such as pneumonia or uncontrolled diabetes. When they develop cancer, it is more often diagnosed at later stages.

But there has been little research on how insurance affects decisions to seek care in life-threatening medical emergencies.

Nearly 1 million people suffer heart attacks each year in the United States.

“For the large majority of patients, the symptoms of a heart attack are very noticeable. It’s a sudden and acute change,” Chan said.

Denial accounts for some of the delays getting to the hospital, Chan said. So does a lack of knowledge about the urgency of a heart attack.

But for the uninsured and underinsured, costs can be the overriding concern.

Medicare pays hospitals on average about $20,000 to treat a heart attack, Chan said. But hospitals may charge private insurance plans and people without insurance considerably more, he said.

“People weigh risks and benefits,” Chan said. “You’ll have to pay something, but you won’t know what it is until you leave the hospital.”

Even when a heart attack isn’t fatal, delaying treatment can have devastating consequences. When patients arrive at the hospital in time, doctors can use stents or clot-busting drugs to restore blood flow to the heart muscle.

“If the patient delays, the heart muscle will die,” Chan said.

One of his patients is Scott, 59, of Kansas City. He works part time for the Park Hill School District and doesn’t have health coverage.

When his chest pains started last December, Scott ignored them at first. He’d take some aspirin, and the pain would go away. But on Dec. 28, the pain wouldn’t quit. He had a hard time catching his breath.

Scott called his brother for help. The phone dropped from his hand. His brother dialed 911.

When the test results came in, Scott learned his heart had lost much of its ability to pump blood.

Scott is taking heart medications now. The heart damage hasn’t slow him down. But he is at risk of developing heart failure.

“If I had medical insurance, this would never have happened,” Scott said. “I would have gotten in (to the doctor) sooner.”

Chan and the other researchers are continuing to follow the patients in the heart attack study. They will be looking at whether the patients’ insurance status affected their health or quality of life a year after treatment, or their odds of survival.

The research is sponsored by the National Institutes of Health.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Customers enter and exit the Costco on Dec. 2, 2022, in Lake Stevens. (Olivia Vanni / The Herald)
Costco stores could be impacted by looming truck driver strike threat

Truck drivers who deliver groceries and produce to Costco warehouses… Continue reading

Two Washington State ferries pass along the route between Mukilteo and Clinton as scuba divers swim near the shore Sunday, Oct. 22, 2023, in Mukilteo, Washington. (Ryan Berry / The Herald)
Ferry system increases ridership by a half million in 2024

Edmonds-Kingston route remains second-busiest route in the system.

Firefighters respond to a 911 call on July 16, 2024, in Mill Creek. Firefighters from South County Fire, Tulalip Bay Fire Department and Camano Island Fire and Rescue left Wednesday to help fight the LA fires. (Photo provided by South County Fire)
Help is on the way: Snohomish County firefighters en route to LA fires

The Los Angeles wildfires have caused at least 180,000 evacuations. The crews expect to arrive Friday.

x
Edmonds police shooting investigation includes possibility of gang violence

The 18-year-old victim remains in critical condition as of Friday morning.

The Everett Wastewater Treatment Plant along the Snohomish River. Thursday, June 16, 2022 in Everett. (Olivia Vanni / The Herald)
Everett council approves water, sewer rate increases

The 43% rise in combined water and sewer rates will pay for large infrastructure projects.

Robin Cain with 50 of her marathon medals hanging on a display board she made with her father on Thursday, Jan. 2, 2025 in Lake Stevens, Washington. (Olivia Vanni / The Herald)
Running a marathon is hard. She ran one in every state.

Robin Cain, of Lake Stevens, is one of only a few thousand people to ever achieve the feat.

People line up to grab food at the Everett Recovery Cafe on Wednesday, Dec. 4, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
Coffee, meals and compassion are free at the Everett Recovery Cafe

The free, membership-based day center offers free coffee and meals and more importantly, camaraderie and recovery support.

Devani Padron, left, Daisy Ramos perform during dance class at Mari's Place Monday afternoon in Everett on July 13, 2016. (Kevin Clark / The Herald)
Mari’s Place helps children build confidence and design a better future

The Everett-based nonprofit offers free and low-cost classes in art, music, theater and dance for children ages 5 to 14.

The Everett Wastewater Treatment Plant along the Snohomish River on Thursday, June 16, 2022 in Everett, Washington. (Olivia Vanni / The Herald)
Everett water, sewer rates could jump 43% by 2028

The rate hikes would pay for improvements to the city’s sewer infrastructure.

The bond funded new track and field at Northshore Middle School on Thursday, Oct. 24, 2024 in Bothell, Washington. (Courtesy of Northshore School District)
Northshore School District bond improvements underway

The $425 million bond is funding new track and field complexes, playgrounds and phase one of two school replacements.

Wade Erickson, maintenance with the Edmonds School District, passes by a school closure sign as he clears snow from the sidewalk in front of Edmonds-Woodway High School on Wednesday, Feb. 5, 2025 in Edmonds, Washington. (Olivia Vanni / The Herald)
UPDATED: Schools close across Snohomish County on Thursday

Snohomish County lowlands remain under cold weather and winter weather advisories.

Modern DNA tech comes through again for Everett police in 1989 murder case

Recent advances in forensic genealogy led to the suspect’s arrest in Clark County, Nevada.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.