Background Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. Methods Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. Results We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015–2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. Conclusions During the 2015–2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.

Background Data about the impact of chronic kidney disease (CKD) on health care costs in Spain are scarce This study was aimed to evaluate cumulative costs and healthcare utilisation in CKD in Spain. Methods Observational, retrospective, population-based study, which included adults who received care for CKD between 2015 and 2019. Healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. Results We identified 44,214 patients with CKD (year 2015: age 76.4 ± 14.3 years, 49.0% women, albumin-to-creatinine ratio 362.9 ± 176.8 mg/g, estimated glomerular filtration rate 48.7 ± 13.2 mL/min/1.73 m2). During the 2015–2019 period, cumulative CKD associated costs reached 14,728.4 Euros, being cardiovascular disease hospitalizations, particularly due to heart failure and CKD, responsible for 77.1% of costs. Total medication cost accounted for 6.6% of the total cost. There was a progressive decrease in cardiovascular disease hospital costs per year (from 2741.1 Euros in 2015 to 1.971.7 Euros in 2019). This also occurred with cardiovascular and diabetic medication costs, as well as with the proportion of hospitalizations and mortality. Costs and healthcare resources use were higher in the DAPA-CKD like population, but also decreased over time. Conclusions Between 2015 and 2019, costs of patients with CKD in Spain were high, with cardiovascular hospitalizations as the key determinant. Medication costs were responsible for only a small proportion of total CKD costs. Improving CKD management, particularly with the use of cardiovascular and renal protective medications may be helpful to reduce CKD burden.

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Objectives To assess mortality, cardiovascular and renal outcomes among patients with chronic kidney disease (CKD) (primary objective), with a particular focus on HF risk following diagnosis of CKD (secondary objective) in Spain. Methods Observational study, comprising cross-sectional and longitudinal retrospective analyses using secondary data from electronic-health records. For primary objective, adults with prevalent CKD (estimated glomerular filtration rate (eGFR) &lt;60 or ≥60 mL/min/1.73m2 with urine albumin-to-creatinine ratio (UACR) ≥30 mg/g at index date (1-January-2017) were included. For secondary objective, adults with incident CKD in 2017 were enrolled. Results In the prevalent population, 46,786 patients with CKD without HF (75.8±14.4 years, eGFR 51.4±10.1 mL/min/1.73 m2; 75.1% under renin-angiotensin system inhibitors) and 8,391 with CKD and HF (79.4±10.9 years; 46.4±9.8 mL/min/1.73 m2) were included. In the prevalent population, the risk of all-cause death (HR 1.107; 95% CI 1.064-1.153), HF hospitalization (HR 1.439; 95% CI 1.387-1.493), UACR progression (HR 1.323; 95% CI 1.182-1.481) was greater in those patients with CKD and HF vs CKD only. For the incident population, 1,594 patients with CKD without HF and 727 with CKD and HF were included. Within 24 months from CKD diagnosis (with/without HF at baseline), 6.5% of patients developed first HF-hospitalization. Although 60.7% were taking renin-angiotensin system inhibitors, only 3.4% were at maximal doses, and among diabetics, 1.3% were taking SGLT-2 inhibitors. Conclusions The presence of HF among CKD patients markedly increases the risk of outcomes. CKD patients have a high risk of HF, which could be partially related to an insufficient treatment.