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Published on: July 12, 2024
Healthcare performance for patients with heart failure in Iran: addressing the tip of the iceberg
Fateme Gorgani1, Mohammadreza Naderian2,3, Shahab Khatibzadeh4
1Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Gorgani_f76@yahoo.com.
Insights
Heart failure patients in Iran face challenges accessing cardiac care, with high costs and limited services. This study highlights gaps in care continuity and advanced treatments, providing a benchmark for healthcare reform.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Chronic diseases, particularly heart failure with reduced ejection fraction (HFrEF), represent a substantial healthcare burden in Iran.
- Effective strategic planning for HFrEF management necessitates comprehensive data on healthcare utilization, costs, and quality of care.
Purpose of the Study:
- To assess healthcare usage patterns for patients diagnosed with HFrEF in Iran.
- To determine the direct medical costs associated with HFrEF management, including out-of-pocket expenses.
- To evaluate the quality of HFrEF care, focusing on diagnostic procedures, follow-up, and medication adherence.
Main Methods:
- The study analyzed nationally representative data from 209 patients diagnosed with HFrEF (ejection fraction < 40%).
- Data collected included healthcare service utilization, direct medical costs, and adherence to recommended care protocols.
- Patient demographics, including a mean age of 58 years, were considered in the analysis.
Main Results:
- Medication dispensing (76%) and outpatient visits (53%) were the most frequent services utilized by HFrEF patients.
- The annual direct medical cost per patient was $1,464, with 21% ($308) paid out-of-pocket, largely for pharmacy expenses.
- While echocardiography was common on admission (91.1%), only 71.6% had timely cardiology follow-up post-discharge, and guideline-directed medical therapy prescription rates were suboptimal (e.g., ACE inhibitors/ARBs at 67.5%).
Conclusions:
- Iranian heart failure patients experience significant barriers to adequate cardiac care, including fragmented care continuity and limited access to advanced services.
- The findings establish a critical benchmark for evaluating and improving HFrEF management strategies within the Iranian healthcare system.
- Addressing these challenges is crucial for enhancing patient outcomes and reducing the overall burden of heart failure.
Background:
Chronic diseases, such as heart failure with reduced ejection fraction (HFrEF), remain significant factors in the healthcare burden in Iran. Healthcare systems must have comprehensive data on the current usage, costs, and quality of care to tackle these challenges and formulate strategic plans effectively.
Methods:
The study included 209 patients with a mean age of 58 years (SD = 16.5) who met the inclusion criteria of having an ejection fraction of less than 40% and a confirmed diagnosis of HFrEF. This study used nationally representative data to assess the healthcare usage, costs, and quality of HFrEF management in Iran.
Results:
The most used services were medication dispensing (76%) and outpatient visits (53%), while rehabilitation (3%) and homecare (2%) were used less frequently. The annual per-patient direct medical cost was $1,464, with $308 (21%) paid out-of-pocket (OOP). Hospitalization accounted for most of the total cost (68%), and pharmacy expenses comprised the largest portion of OOP payments (46%). Echocardiography was performed for 91.1% of patients upon admission. Only 71.6% of patients had arrangements for a cardiology visit within seven days following hospital discharge. Additionally, only 67.5% of patients received prescriptions for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and 85% were prescribed beta-blockers.
Conclusion:
Patients with heart failure in Iran face challenges in accessing adequate cardiac care, including a lack of care continuity and advanced cardiac services. The study provided an essential benchmark for future healthcare reform.
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