Seven in 10 heart failure patients in India lack financial security; cost of treatment leaves families struggling

NEW DELHI: For thousands of Indians suffering from heart failure, the biggest stress is not just the disease but the cost of survival. A national study found that seven in 10 patients are financially insecure, forcing families to pay almost entirely out of pocket.published in journal global heartThe study, led by Dr. Panniyammakal Jeemon from SCTIMST, Thiruvananthapuram, analyzed 1,859 patients from 21 tertiary care hospitals in India between September 2019 and December 2022.Data show that more than 90% of treatment costs are directly borne by patients, and there is a huge gap in financial protection for chronic diseases.These figures reflect the harsh reality. On an average, patients spend over Rs 1 lakh per year on treatment. At the same time, incomes are declining—nearly one-third of patients and more than one-third of families report a drop in income after diagnosis.Doctors say incomes tend to drop as patients stop working and families cut back on providing care. About 38% faced catastrophic expenses, nearly one in six borrowed or sold assets, and many of them cut essential expenses. The burden is greatest among rural, low-income, and uninsured patients.Insurance can provide some relief—but not enough. Schemes like Ayushman Bharat offer hospitalization cover, but gaps remain. Most plans don’t fully cover outpatient care, medications and long-term follow-up — the main parts of treatment for chronic conditions like heart failure. As a result, patients continue to spend significant amounts of money out of pocket.“There is a clear gap in heart failure care in India between acute treatment and long-term management due to affordability, accessibility and availability,” said Dr. Mohit Gupta, cardiologist at GTB Hospitals. “Cost often forces patients to cut back on medications, delay follow-up visits, or skip tests. The biggest burden is repeat hospitalizations, not medications. We often tailor treatment based on what patients can afford. Insurance primarily covers hospitalization costs, but heart failure is a chronic outpatient condition, and gaps in coverage for medications and follow-up care leave patients vulnerable. Expanding access to affordable medicines and structured follow-up can improve outcomes and reduce costs. “Dr Ambuj Roy, professor of cardiology at AIIMS, said insurance plans still favor one-time surgeries over ongoing care, whereas heart disease requires long-term treatment. Although new drugs have improved survival and quality of life, most patients pay out of pocket, making heart failure treatment a significant financial burden. “Experts warn that financial constraints can lead to delays in care and missed doses of medication, which can worsen outcomes. While access has improved, financial protection still lags, making coverage of outpatient care and pharmaceuticals critical.