NEW DELHI: For thousands of Indians living with heart failure, the biggest strain is not just the disease, but the cost of surviving it. A nationwide study has found that seven out of 10 patients have no financial protection, forcing families to pay almost entirely from their own pockets.Published in the journal Global Heart, the study led by Dr Panniyammakal Jeemon of SCTIMST, Thiruvananthapuram, analysed 1,859 patients across 21 tertiary hospitals in India between September 2019 and December 2022.It shows that over 90% of treatment expenses are borne directly by patients, exposing a deep gap in financial protection for chronic illnesses.The numbers reflect a harsh reality. On average, a patient spends more than ₹1 lakh a year on treatment. At the same time, incomes are falling — nearly one in three patients and over a third of households reported a drop in earnings after diagnosis.Doctors say income often drops as patients stop working and families cut back to provide care. About 38% face catastrophic spending and nearly one in six borrow or sell assets, with many cutting basic expenses. The burden is highest on rural, low-income and uninsured patients.Insurance offers some relief — but not enough. Schemes such as Ayushman Bharat provide coverage for hospitalisation, but gaps remain. Most schemes do not fully cover outpatient care, medicines and long-term follow-up — which form a major part of treatment in chronic conditions like heart failure. As a result, patients continue to spend heavily from their own pockets.“Heart failure care in India shows a clear gap between acute treatment and long-term management, driven by affordability, accessibility and availability,” said Dr Mohit Gupta, cardiologist at GTB Hospital. “Costs often force patients to cut medicines, delay follow-ups or skip tests. The biggest burden is repeated hospitalisation, not drugs. We frequently tailor treatment to what patients can afford. Insurance largely cover hospitalisation, but heart failure is a chronic outpatient disease, and gaps in covering medicines and follow-up care leave patients vulnerable. Expanding access to affordable drugs and structured follow-up can improve outcomes and reduce costs.”Dr Ambuj Roy, Prof in cardiology, AIIMS said that insurance schemes still favour one-time procedures over sustained care, while heart diseases demand long-term therapy. Even though newer drugs have improved survival and quality of life, most patients pay out of pocket, making heart failure treatment a significant financial burden.”Experts warn financial strain leads to delayed care and skipped medicines, worsening outcomes. Despite improved access, financial protection lags, making coverage of outpatient care and medicines critical.