**1. Introduction**

Cardiovascular diseases (CVDs) are regarded as a broader concept describing diseases of the heart or blood vessels, including coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other conditions [1]. The development of CVD is linked with build-up of fatty deposits in the arteries resulting in a condition called atherosclerosis, increased risk of blood clots, and damage to arteries in organs such as the brain, heart, kidneys, and eyes [2]. Detection of cardiovascular diseases at an early age permits possible management before the development of adverse effects, which may be costly to manage. The risk for the development of CVD includes behaviors such as unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol [3]. The effects of these behaviors may present in the form of increased blood

pressure, glucose, and lipids, including overweight and obesity. On that background, the CVD can be prevented through behavioral interventions aimed at addressing these risk factors [3]. Moreover, behavioral interventions could be helpful in minimizing costs of care and also curb prevalence of cardiovascular diseases.

The care of cardiovascular disease is expensive and requires more state resources leading to delay in the development of the country due to increased healthcare expenditure and diminished productivity from disability, premature death, and absenteeism [4]. It has been reported that patients diagnosed with cardiovascular diseases incur more than double the medical costs as compared to a patient without CVD of the same age and sex [5]. Patients living with cardiovascular diseases and requiring medical treatment are unable to receive such due to financial constraints. These financial implications manifest themselves in the form of physical barriers (transportation to the healthcare facility), and system barriers (lack of medication at the healthcare facilities) [6]. It has been discovered that patients experience financial barriers related to payment of medical costs and visit to health care which may require transportation costs [7]. In addition, in the event of long queues at the healthcare facilities, patients may need lunch money. Furthermore, it has been found that there are also indirect financial barriers, which may occur when a certain patient who has a child may need to pay for someone to look after the child while visiting the healthcare facilities [6]. Various studies have indicated that patients experiencing financial barriers are likely not to adhere to medical therapies or health behavior change due to direct or indirect financial costs [8, 9]. On that basis, patients' outcomes are impacted by financial barriers and cost-related non-adherence, leading to deterioration in the quality of life, poor health status, and general well-being, and may also increase the rates of hospitalization [6]. Moreover, CVDs do not only impact the health, quality of life, and general well-being of patients, but also burden the individual and his/her family financially [4]. These may also lead to the underdevelopment of the family and consequently lead to financial burden and re-channeling of state resources. This may result in financial toxicity. Financial toxicity can be described as healthcare-related at the patient level and state expenditure related to provision of medical care and improving quality of life of patients. State experiences more financial costs due to rising medication costs [10]. The primary healthcare facilities which provide care to outpatients must emphasize more on these behavioral interventions as cost-effective strategy to curb cardiovascular diseases.
