A large multi-centre study across 21 institutions in India has found that heart failure is among the country's most financially ruinous illnesses, driving households into catastrophic health spending, debt, and distress borrowing. Only one in three patients had any health insurance coverage, and even those who did faced enormous out-of-pocket costs, as chronic disease management requires frequent hospital visits and long-term medication that existing insurance schemes do not cover. The findings highlight a critical gap in India's health financing system, where the long-term costs of chronic conditions fall almost entirely on patients and their families.