Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction

Juan Carlos López‐Azor; Juan F. Delgado; Jorge Íván Bonilla Vélez; Rocío Rodriguez; Jorge Solı́s; Manuel del Oro; Carmen Ortega; Rafael Salguero‐Bodes; Beatriz Palacios; Lourdes Vicent; Guillermo Moreno; Nicolás Rosillo; Luis Varela; Margarita Capel; Fernando Arribas; José Bernal; Héctor Bueno

doi:10.1016/j.rec.2023.06.003

June 16, 2023Revista Española de Cardiología (English Edition)Open Access

Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction

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Why the study?

The impact of left ventricular ejection fraction on health care resource utilization and costs in heart failure patients is not well known.

Structured PICO

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Population

1287 patients with a primary diagnosis of heart failure (excluding newly diagnosed) presenting to an emergency department or admitted to a tertiary hospital in Spain in 2018. Mean age 80.1, 57.1% female. 14.7% HFrEF, 11.4% HFmrEF, 73.9% HFpEF.

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Outcome

One-year clinical outcomes, costs and health care resource utilization (HCRU)

Heart failure with reduced ejection fraction is associated with significantly higher healthcare costs and resource utilization compared to preserved or mildly reduced ejection fraction, driven by more frequent ICU admissions and diagnostic/therapeutic tests.

Implication

LVEF may inform HCRU planning in chronic HF; leaves open whether targeted strategies reduce HFrEF costs.

Abstract

INTRODUCTION AND OBJECTIVES: The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. METHODS: Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). RESULTS: Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. CONCLUSIONS: In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.