New Delhi: For thousands of Indians living with heart failure, the biggest stress is not just the disease itself, but also the cost of avoiding it. A nationwide study found that seven out of 10 patients have no financial protection, leaving families to pay almost entirely out of pocket.published in journal global heartThe study led by Dr Panniamakkal Jeemon of SCTIMST, Thiruvananthapuram, analyzed 1,859 patients across 21 tertiary hospitals in India between September 2019 and December 2022.This shows that more than 90% of treatment costs are borne directly by patients, highlighting a deep gap in financial security for chronic diseases.The numbers reflect a harsh truth. On an average, a patient spends more than ₹1 lakh per year on treatment. Additionally, income is declining – nearly one in three patients and more than a third of families report a decline in income after diagnosis.Doctors say income often drops as patients stop working and families cut back on providing care. Nearly 38% face catastrophic spending and nearly one in six borrows money or sells assets, with many cutting back on basic expenses. The burden is greatest on rural, low-income and uninsured patients.Insurance provides some relief – but not enough. Schemes like Ayushman Bharat provide coverage for hospitalization, but shortcomings remain. Most plans don’t fully cover outpatient care, medications, and long-term follow-up – which are a major part of treatment in chronic conditions like heart failure. As a result, patients have to spend heavily out of their own pockets.“Heart failure care in India shows a clear distinction between acute treatment and long-term management, driven by affordability, accessibility and availability,” said Dr Mohit Gupta, cardiologist, GTB Hospital. “Costs often force patients to cut back on medications, delay follow-up, or skip trials. The biggest burden is not the medications, but frequent hospitalizations. We often treat patients according to their capacity. Insurance largely covers hospitalization, but heart failure is a chronic outpatient disease, and gaps in covering medications and follow-up care leave patients vulnerable. Increasing access to affordable medicines and structured follow-up can improve outcomes and reduce costs.Dr Ambuj Roy, professor in cardiology at AIIMS, said insurance schemes still prioritize one-time procedures rather than continuous care, while heart diseases demand long-term therapy. Even though 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 stress leads to delays in care and skipping medications, worsening outcomes. Despite improved access, financial security is lagging, making coverage of outpatient care and medicines critical.