Clinical Characteristics and Clinical Outcomes of Patients with Heart Failure Who Receive Public Assistance in Japan

Abstract

Background: The number of patients with heart failure (HF) is increasing, which is a socio-economic problem. Past overseas studies have reported that low-income patients with HF do not receive adequate treatment for financial reasons and have poor clinical outcomes. In Japan, medical expenses are free if they receive public assistance called Seikatsu hogo (PA), and there is no disadvantage to low-income patients regarding medical expenses. The purpose of this study is to investigate the clinical characteristics of patients with HF who receive PA in Japan. Methods: We enrolled 301 patients who were admitted to our hospital for the congestive HF. We divided patients into groups of patients receiving PA (PA group, N = 51) and groups of patients not receiving PA (Non-WPA group, N = 250). We compared patient clinical characteristics at admission, and the incidence of one-year cardiovascular events (cardiac death, readmission for HF) in both groups. Results: The PA group was significantly younger (71.1y ± 12.7 vs. 79.9y ± 12.4 P < 0.001) and more smokers (62.7% vs. 35.6% P < 0.001) than the Non-PA group. The left ventricular ejection fraction was significantly lower in the PA group than in the Non-PA group (34.6% ± 17.9 vs. 43.0% ± 18.7 P = 0.04). There was no significant difference in mortality between the two groups. The incidence of readmissions for HF was significantly higher in the PA group than in the Non-PA group (33.3% vs. 18.2% P = 0.02). Conclusion: Patients with HF who received public assistance had a poor cardiac function, and the incidence of readmission due to HF was high.