Key result
Worsening heart failure in HFrEF is linked to ~35% higher 30-day readmissions and increased mortality.
Why the study?
The impact of worsening heart failure events on quality outcomes, healthcare resource utilization, and costs in Medicare beneficiaries with chronic HFrEF was not well characterized.
Does a worsening heart failure event increase healthcare resource utilization, costs, and mortality in Medicare patients with chronic HFrEF?
Observational (n=1,211,154)
Does a worsening heart failure event increase healthcare resource utilization, costs, and mortality in Medicare patients with chronic HFrEF?
Absolute Event Rate: 42% vs 31%
p-value: p=<.05
Worsening heart failure events in Medicare patients with HFrEF are associated with significantly higher mortality, healthcare resource utilization, and costs.
Worsening HF events flag high short-term risk in Medicare HFrEF; leaves open whether targeted interventions improve outcomes.
Aims The study compared quality outcomes, resource utilization, and costs in Medicare beneficiaries with chronic heart failure with reduced ejection fraction (HFrEF) with and without a worsening heart failure event (WHFE).Methods This retrospective observational study evaluated claims data for two cohorts of Medicare beneficiaries with chronic HFrEF who were enrolled in Medicare fee-for-service (FFS) or Medicare advantage (MA) plans. The index date was the first claim of HFrEF between October 2015 and September 2017. Patients with WHFE were identified if they had IV diuretic use or hospitalization for HF during 12 months after index date; with remaining patients classified as non-WHFE. During follow-up, starting from the 13th month after HFrEF index date to end of follow-up, generalized linear models were used to adjust for patient characteristics to compare mean per patient per year (PPPY) quality outcomes, resource utilization, and costs between HFrEF patients with and without WHFEResults Of the 1,182,509 FFS and 28,645 MA patients with HFrEF, 34.2% and 32.5% developed WHFE, respectively. Compared to patients without WHFE, patients with WHFE had higher rates of all-cause 30-day readmissions (FFS: 42% vs. 31%; MA: 41% vs. 31%), hospitalizations (FFS: 2.27 vs. 1.36; MA: 1.47 vs. 0.78 PPPY) and ED visits (FFS: 1.82 vs. 1.25; MA: 1.43 vs. 0.96 PPPY); all comparisons p < .05. Mortality rates in FFS patients were higher among patients with WHFE (34.3%) compared to those without (23.4%). All-cause total PPPY costs were higher for patients with WHFE compared to those without by $20,825 in FFS and $15,974 in MA. Similar trends were observed for HF-related outcomes.Conclusion Medicare patients with chronic HFrEF experiencing a WHFE had worse quality outcomes as well as higher resource utilization and costs compared to those without WHFE, thus, suggesting the need for better treatments and interventions to manage these patients.
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Mentz et al. (2021) conducted an observational in chronic heart failure with reduced ejection fraction (HFrEF) (n=1,211,154). Worsening heart failure event (WHFE) vs. No worsening heart failure event was evaluated on All-cause 30-day readmissions (Fee-for-service) (p=<.05). A worsening heart failure event in Medicare patients with HFrEF was associated with higher rates of all-cause 30-day readmissions (42% vs 31% in FFS) and mortality (34.3% vs 23.4%).
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