Background: Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India. Methods: We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT). Results: We recruited 1, 859 participants. Nearly one-third of participants (30. 2%) were women. The mean age was 55. 9 (11. 3) years, and the mean duration of formal education was 11. 3 (3. 8) years. Health insurance coverage was reported in one-third (32. 2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1, 06, 566 (INT 4, 709. 10), constituting 92. 6% (95% CI: 92. 5–92. 7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32. 3% of individuals and 36. 2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37. 7% (35. 5–39. 9) and 17. 7% (15. 9–19. 4) of the households, respectively. However, CHS and DF were lower 30. 8% (26. 2–35. 4) and 13. 6% (10. 2–17. 0), respectively among those with health insurance compared to the uninsured 40. 3% (37. 6–43. 0) and 18. 9% (16. 7–21. 1), respectively. Conclusion: Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.
Jeemon et al. (2026) studied this question.