Management by a community-based heart failure multidisciplinary team significantly reduced hospitalization costs by 27% (RR 0.73) compared to the 12 months prior to intervention.
Cohort (n=962)
No
Does multidisciplinary team management in a community-based heart failure unit reduce healthcare utilization and costs in patients with NYHA class III-IV heart failure?
Intensification of therapy by a dedicated multidisciplinary team in a community-based heart failure unit significantly reduces healthcare utilization and costs, primarily driven by decreased hospitalizations.
Effect estimate: RR 0.73 (95% CI 0.62-0.87)
Absolute Event Rate: 4454% vs 5162%
p-value: p=<0.001
AIMS: Multidisciplinary team (MDT) management in heart failure (HF) is recommended to reduce mortality and HF hospitalization. We investigated whether an MDT in a community-based HF unit (HFU) impacted patients' healthcare utilization (HCU) and costs. METHODS AND RESULTS: A retrospective cohort study was conducted among HF patients who visited at least once in a regional community-based HFU, established for ambulatory specialist care for New York Heart Association Functional Classes III and IV, between January 2012 and August 2019. HCU data were obtained from the health maintenance organization's claims data for 12 months before and after first HFU visit. Multivariable generalized estimating equation models were specified for the annual average change in total healthcare utilization and hospitalization costs. Our cohort consisted of 962 patients, of whom 843 (87. 6%) completed at least 12 months of follow-up (Group A) and 119 (12. 4%) died within 12 months following their first visit (Group B). Both groups were comparable regarding sex, socio-economic status, Charlson Comorbidity Index, ischaemic heart disease, and/or carotid artery disease. Those who died within 12 months were older and had more hypertension, diabetes, chronic renal disease, and malignancy. There was a significant reduction in the total average annual HCU costs of the entire study population 12 months after the first HFU visit 12 675 (±17 210) after vs. 13 188 (±15 011) before, P = 0. 014. This was driven by a reduction in costs among patients who completed 12 months of follow-up 11 955 (±17 352) after vs. 13 112 (±15 268) before, P < 0. 001, whereas an increase in these costs was observed among patients who died during follow-up 17 774 (±15 292) after vs. 13 728 (±13 093) before, P = 0. 015. These opposite trends stem mainly from a decrease 3540 (±8991) after vs. 4941 (±6806) before, P < 0. 001 vs. increase 10 932 (±11 660) after vs. 6733 (±7215) before, P = 0. 002 in hospitalization costs of these groups, respectively. The multivariable models revealed that patients who died within 12 months following the first visit to the HFU demonstrated a significant increase of 57% in hospitalization costs following their first visit relative risk (RR) = 1. 57, 95% confidence interval (CI): 1. 20-2. 05, P = 0. 001, whereas there was a decrease of 34% in the hospitalization costs of patients who completed 12 months of follow-up after their first visit (RR = 0. 66, 95% CI: 0. 54-0. 81, P < 0. 001). The entire cohort demonstrated 27% decrease in hospitalization costs following their first HFU visit (RR = 0. 73, 95% CI: 0. 62-0. 87, P < 0. 001). CONCLUSIONS: Intensification of therapy by a dedicated MDT significantly reduced healthcare utilization and costs, predominantly due to a decrease in hospitalizations.
Weinstein et al. (Sun,) conducted a cohort in Heart failure (NYHA III and IV) (n=962). Community-based heart failure multidisciplinary team (MDT) clinic vs. 12 months before first HFU visit was evaluated on Hospitalization costs (RR 0.73, 95% CI 0.62-0.87, p=<0.001). Management by a community-based heart failure multidisciplinary team significantly reduced hospitalization costs by 27% (RR 0.73) compared to the 12 months prior to intervention.