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60 A comparison of HFrEF vs HFpEF’s clinical workload and cost in the first year following hospitalisation and enrollment in a disease management program
  1. T Murphy1,
  2. D Waterhouse1,
  3. S James1,
  4. C Casey1,
  5. E Fitzgerald1,
  6. E O’Connell1,2,
  7. C Watson1,
  8. J Gallagher1,
  9. M Ledwidge1,
  10. K McDonald1
  1. 1St. Vincent's University Hospital Dublin, Ireland
  2. 2Centre for Experimental Medicine, Queens University Hospital, Belfast, UK

Abstract

Background Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HF with preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype.

Methods 1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorised as HFpEF (EF ≥ 45%) or HFrEF (EF < 45%). Hospitalizations, primary care, medications, and DMP workload with associated costs were evaluated assessing DMP clinic visits, telephonic contact, medication changes over 1 year using a mixture of casemix and micro-costing techniques.

Results The total average annual cost per patient was marginally higher in patients with HFrEF €13,011 (12011, 14078) than HFpEF, €12206 (11009, 13518). However, emergency non-cardiovascular admission rates and average cost per patient were higher in the HFpEF vs HFrEF group (0.46 vs 0.31 per patient/12 months). In the first 3 months of the outpatient HF-DMP the HFrEF population cost more on average €791(764,819) vs €693(660,728).

Conclusion There are greater short-term (3 month) costs of HFrEF versus HFpEF as part of a HF-DMP following an admission. However, long-term (3–9 month) costs of HFpEF are greater because of higher non-cardiovascular rehospitalisations. As HFpEF becomes the dominant form of HF, more work is required in HF-DMPs to address non-cardiovascular rehospitalisations and to integrate hospital based HF-DMPs into primary healthcare structures.

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