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Costs associated with symptomatic systolic heart failure
P G Davey1, P B Clarkson, A McMahon
1MEMO (Medicines Monitoring), University Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee, Scotland. peter@memo.dundee.ac.uk
Insights
Systolic dysfunction in heart failure patients significantly increases healthcare costs, highlighting the potential for cost savings through improved cardiac function. This study focused on primary care patients with mild heart failure.
Area of Science:
- Cardiology
- Health Economics
Background:
- Heart failure (HF) management incurs substantial healthcare and social support costs.
- Systolic dysfunction is a key indicator of HF severity and prognosis.
Purpose of the Study:
- To determine if the degree of systolic dysfunction predicts healthcare and social support costs in heart failure patients.
- To assess the economic impact of systolic dysfunction in a primary care setting.
Main Methods:
- A cross-sectional study was conducted in four Scottish primary care practices.
- Echocardiography (two-dimensional and Doppler) assessed left ventricular (LV) systolic function in patients on loop diuretics.
- Cost data for healthcare and social support were collected for the previous year.
Main Results:
- Patients with abnormal systolic function (30%) had higher healthcare costs (£560 vs. £440 per patient year) and were more likely to incur hospital costs (OR: 2.02).
- Primary care costs were significantly higher for patients with systolic dysfunction (mean £292 vs. £231 per patient year; p=0.02).
- No significant difference was found in social support costs, with lower mean costs observed in patients with systolic dysfunction (£234 vs. £373).
Conclusions:
- Objectively measured systolic dysfunction is associated with significantly higher healthcare expenditures in heart failure patients.
- Improving systolic function may lead to reduced healthcare costs, even in primary care populations with mild heart failure.
- These findings support the economic rationale for interventions aimed at enhancing systolic function in heart failure management.
Objective:
To investigate whether the extent of systolic dysfunction is a useful predictor of the costs of healthcare and social support for patients with heart failure.
Design:
Cross-sectional study with collection of cost data attributed to management of heart failure in the previous year.
Setting:
Four primary-care practices in Scotland.
Patients:
Patients receiving long term therapy with loop diuretics for suspected heart failure.
Interventions:
Two-dimensional and Doppler echocardiography.
Main Outcome Measures And Results:
Two hypotheses were tested: (i) the proportion of patients incurring costs is higher in patients with abnormal left ventricular (LV) function; and (ii) the median cost per patient that incurs costs is higher in patients with abnormal LV function. Of the 226 patients in the study, 67 (30%) had abnormal systolic function. In comparison with the remaining 159 patients, they had higher healthcare costs [560 Pounds vs 440 Pounds per patient year (1994/1995 values)], were more likely to incur hospital inpatient or outpatient costs [Odds ratio (OR): 2.02; 95% confidence interval (CI): 1.06 to 3.84] and had significantly higher primary-care costs (mean 292 Pounds vs 231 Pounds per patient year; p = 0.02, Mann Whitney test). In contrast, they were no more likely to incur social support costs (OR: 1.22; 95% CI: 0.52 to 2.86) and the mean cost of social support per patient year was lower (234 Pounds vs 373 Pounds).
Conclusions:
Patients with objectively measured systolic dysfunction incurred significantly higher healthcare costs in the year before diagnosis. This suggests that treatment that improves systolic function will reduce healthcare costs, even in a primary-care population with relatively mild congestive heart failure.