• Nathaniel A Erskine, Molly E Waring, David D McManus, Darleen Lessard, Catarina I Kiefe, and Robert J Goldberg.
• Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
• J Gen Intern Med. 2018 Sep 1; 33 (9): 1543-1550.

BackgroundBarriers to healthcare are common in the USA and may result in worse outcomes among hospital survivors of an acute coronary syndrome (ACS).ObjectiveTo examine the relationship between barriers to healthcare and 2-year mortality after hospital discharge for an ACS.DesignLongitudinal study.SettingSurvivors of an ACS hospitalization were recruited from 6 medical centers in central Massachusetts and Georgia in 2011-2013.PatientsStudy participants with a confirmed ACS reported whether they had a financial-related healthcare barrier, no usual source of care, or a transportation-related healthcare barrier around the time of hospital admission.InterventionsNone.MeasurementsCox regression analyses calculated adjusted hazard ratios (aHRs) for 2-year all-cause mortality for the three healthcare barriers while controlling for several demographic, clinical, and psychosocial characteristics.ResultsThe mean age of study participants (n = 2008) was 62 years, 33% were women, and 77% were non-Hispanic white. One third of patients reported a financial barrier, 17% lacked a usual source of care, and 12% had a transportation barrier. Five percent (n = 100) died within 2 years after hospital discharge. Compared to patients without these barriers, those lacking a usual source of care and with barriers to transportation experienced significantly higher mortality (aHRs 1.40, 95% CI 1.30 to 1.51 and 1.46, 95% CI 1.13 to 1.89, respectively). Financial barriers were not associated with all-cause mortality (aHR 0.79, 95% CI 0.60 to 1.06).LimitationsObservational study with other unmeasured potentially confounding prognostic factors.ConclusionsAbsence of an established usual source of care and inconsistent transportation availability were associated with a higher risk for dying after an ACS. Patients with these barriers to follow-up care may benefit from more intensive follow-up and support.

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