Health-Related Quality of Life, Healthcare Utilization, and Expenditure in US Adults With Myocardial Infarction and Heart Failure: The Medical Expenditure Panel Survey 2019 to 2024

Background

Myocardial infarction (MI) and heart failure (HF) impose a physical and emotional toll that has not been measured nationally with a standard instrument.

Methods

We pooled the 2019 to 2024 Medical Expenditure Panel Survey into 4 mutually exclusive groups of adults aged 18 and older: MI without HF, HF without MI, both conditions, and neither condition. Quality of life was assessed with the Veterans RAND 12-item component summaries, T scores (mean 50, SD 10) on which higher is better and 3 points is minimally important. Survey-weighted linear regression adjusted for demographics, socioeconomic factors, and comorbidity.

Results

Among 79,853 adults representing 253.8 million US adults, 4.2% (3,340) had MI alone, 0.6% (480) HF alone, and 0.3% (236) both. Unadjusted physical scores ranged from 33.2 with HF alone to 39.1 with MI alone, versus 50.5 with neither. Adjusted physical scores were lower by 3.84 points (95% CI, 3.20-4.47) with MI alone, 8.32 (95% CI, 7.04-9.61) with HF alone, and 7.74 (95% CI, 5.73-9.76) with both, each beyond the minimally important threshold. Adjusted mental scores were lower by 1.35 points with MI alone, 1.20 with HF alone, and 1.69 with both, all below that threshold. Adults with both conditions did not differ from those with HF alone (0.58 points; 95% CI, -1.76 to 2.92). Emergency visits, inpatient discharges, and expenditure were higher in every cardiac group and highest with both conditions, where annual expenditure reached $37,198 versus $7,845 with neither.

Conclusions

Physical quality of life fell steadily across the cardiac groups, with HF rather than prior MI accounting for most of it. The difference in mental quality of life did not persist after adjustment. Utilization and spending were highest with both conditions.

WHAT IS KNOWN

Myocardial infarction and heart failure are leading contributors to morbidity and to healthcare spending in the United States, and expenditure for each has been estimated in nationally representative data.

Patient-reported outcomes have been described within broader atherosclerotic cardiovascular disease populations, where depression risk is associated with worse reported health and higher spending.

WHAT THE STUDY ADDS

This study quantifies health-related quality of life against the general US adult population for myocardial infarction and heart failure held apart from one another, and shows that the physical burden of heart failure is more than twice that of prior infarction.

Carrying both conditions adds no measurable decrement beyond heart failure alone, and the difference in mental quality of life does not persist after adjustment for age and coexisting illness.

Unadjusted annual spending rose from $19,876 in myocardial infarction alone to $34,002 in heart failure alone and $37,198 with both conditions, against $7,845 in adults with neither. Spending was highest among adults with both conditions, while physical quality of life was lowest among those with heart failure alone. Expenditure alone may therefore not capture how patients in these groups report feeling.