(Reuters Health) - Roughly 45 percent of Americans under 65 who have cardiovascular disease experience financial hardships from medical bills, a U.S. study suggests.

And, almost one in five of them can’t afford to pay their medical bills at all.

“Patients and doctors often don’t have a conversation about financial hardship or distress – being due to a feeling of awkwardness, being judged, fear or even being stigmatized,” lead study author Dr. Javier Valero-Elizondo of Yale University in New Haven, Connecticut, said by email.

This type of distress has become so common among Americans with chronic diseases that scientists have taken to calling it “financial toxicity,” a phrase coined to evoke side effects on par with complications from drugs or surgery that can have lasting effects on patients’ physical and mental health.

In the current study, researchers focused on adults under 65 with atherosclerotic cardiovascular disease (ASCVD), a condition that includes heart attacks as well as blockages or narrowing of the arteries in the heart or chest pain caused by reduced blood flow to the heart.

ASCVD is the leading cause of death and disability in the U.S. and one of the costliest conditions for patients, researchers note in the Journal of the American College of Cardiology. Even among insured patients, many people with these heart problems are prone to financial hardship because of the high cost of insurance, including deductibles, co-pays and co-insurance.

Patients with heart disease typically have out-of-pocket health costs of more than $2,000 a year, with more than half of that tab paying for medications, the study authors note.

“The costs of managing ASCVD are substantial and constitute a major source of concern at a personal level, especially for low-income families and uninsured patients who generally may not have enough financial reserves with which to offset the burden of unexpected health care expenditures,” said senior author Dr. Khurram Nasir, also of Yale University.

To assess the financial burden of heart disease, researchers looked at data from the 2013 to 2017 National Health Interview Surveys on 6,160 adults under 65 with heart disease.

Survey respondents were defined as having financial hardship from medical bills if they or anyone in their family reported having problems paying medical bills in the past year or were currently paying off medical bills over time. If they reported problems paying bills, they were then asked if they have bills they are unable to pay at all.

Lower income and higher income individuals, as well as insured and uninsured reported financial hardship and inability to pay; however, the highest burden of financial hardship and inability to pay was reported among uninsured and poor Americans.

About one in three heart disease patients with financial hardship from their medical bills had to cut back on necessities like food or forgo needed medications as a result, the study found. One in five patients unable to pay their bills had to both cut back on both food and drugs.

One limitation of the study is that researchers lacked data from medical bills to explore the exact amount of patients’ out-of-pocket costs or what proportion of their income might be consumed by paying these bills.

Another drawback is that even though the study focused on which patients with heart disease had stress related to medical bills or unpaid bills, it doesn’t show whether the money problems were from bills for heart disease or another condition.

Even so, the results suggest that a great number of heart disease patients are under so much financial stress from health costs that they’re skipping medicines that can prevent complications and death from heart disease, said Dr. David Himmelstein, a public health researcher at the City University of New York at Hunter College who wasn’t involved in the study.

“In essence, unless you are Jeff Bezos, you’re just one major illness away from financial ruin,” Himmelstein said by email. “To address this problem we need a major overhaul of health insurance - I favor a single payer reform - and improved disability coverage.”

SOURCE: bit.ly/2I5W5AU Journal of the American College of Cardiology, online February 11, 2019.