A Reevaluation of the Costs of Heart Failure and Its Implications for Allocation of Health Resources in the United States

Voigt, Jeff; John, M. Sasha; Taylor, Andrew J.; Krucoff, Mitchell W.; Reynolds, Matthew R.; Gibson, C. Michael

doi:10.1002/clc.22260

Cited by 115 publications

(88 citation statements)

References 32 publications

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“…We assembled data on inpatient, outpatient, and emergency room (ER) visits, and prescription medication use. This differs from previous studies on HF costs that have either focused on shorter periods of time (a few years 3,32 or the last few months of life 4 ), on in-patient care/hospital costs only; 5–8,30 or have mainly predated the widespread use of novel devices like cardiac resynchronization and defibrillator 9 or left ventricular assist device, 10 as well as heart transplant, which have costs that can potentially outweighs all the other HF costs. Of note, some aspects of the other studies that used the MSEP data differed significantly from ours.…”

Section: Discussioncontrasting

confidence: 66%

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011

Echouffo‐Tcheugui

Bishu

Fonarow

et al. 2017

American Heart Journal

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Background Population-based national data on the trends in expenditures related to heart failure (HF) is scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Methods Using 10-year data (2002–2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194 U.S adults aged ≥18 years) and a two-part model (adjusting for demographics, comorbidities and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures). Results Compared to expenditures for individuals without HF ($5,511 [95% confidence interval (CI): 5,405–5,617]), individuals with HF had a four-fold higher mean expenditures of ($23,854 [95%CI: 21,733–25,975]). Individuals with HF had $3,446 (95%CI: 2,592–4,299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95%CI: 18,359–24,272) in 2002/2003 to $27,152 (95%CI: 20,066–34,237) in 2010/2011; and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/year and the adjusted total incremental expenditure $5.8 billion/year. Conclusions Heart failure is costly and over a recent 10-year period, direct expenditure related to HF increased markedly, mainly driven by inpatient costs.

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Section: Discussioncontrasting

confidence: 66%

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011

Echouffo‐Tcheugui

Bishu

Fonarow

et al. 2017

American Heart Journal

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“…7,8,11,12 The inclusion of outpatient encounters in assessing the adverse impact of chronic RV pacing is particularly relevant given estimates that physician visits for HF account for ≈2% of all outpatient office visits and cost the healthcare system >$2 billion per year in the United States, representing an important opportunity for curbing healthcare expenditures. 27 Although it has been suggested that all patients undergoing pacemaker implantation with a predicted high burden of RV pacing should be implanted with a biventricular device, 7 the results of the PREVENT-HF study 28 and the preliminary results of the BioPace study 25,29 suggest that such a broad approach to biventricular pacing may not be justified. In general, patients with PICM seem to benefit from upgrade to biventricular pacing.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Merchant

Hoskins

Musat

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background-Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB. Methods and Results-A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB.Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62-3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48-1.79; P<0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08-1.25; P<0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB. Conclusions-Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing. Study PopulationPatients were selected for study inclusion if they were implanted with a de novo dual-chamber pacemaker (Current Procedural Terminology code 33208 and Healthcare Common Procedure Coding System codes C1785 and C2619) from any manufacturer between April 1, 2008, and March 31, 2014. Patients with a left ventricular lead placed (Current Procedural Terminology codes 33224 or 33225) at the time of pacemaker implantation were excluded. De novo implants were identified as pacemaker patients without a previous device implantation and without a remote or in-office pacemaker follow-up visit in the 1 year before implantation. An enrollment indicator confirmed active inclusion in the MarketScan databases for each patient per month. Patients were required to have at least 1 year of continuous enrollment in the MarketScan database before and after pacemaker implantation and to be ≥18 and ≤100 years of age at the time of pacemaker implantation.To evaluate the impact of atrioventricular block (AVB) on the development of HF after pacemaker implantation, patients wi...

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“…Acute heart failure (AHF) results in greater than 1 million hospitalisations per year in the USA alone, resulting in over $60 billion cost 1 2. Hospitalisation for AHF portends a poor prognosis, including a 25% 30-day readmission rate and 30% 1 year mortality rate 3 4.…”

Section: Introductionmentioning

confidence: 99%

Serelaxin and acute heart failure

Tietjens

Teerlink

2015

Heart

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Attempts at developing novel therapeutic agents for acute heart failure (AHF) over the past two decades have been marked by disappointment. Relaxin is a human peptide hormone believed to mediate many adaptive haemodynamic changes that occur during pregnancy. Because these effects may be useful for treating AHF, a recombinant version of human relaxin-2, serelaxin, has been developed as a novel therapeutic agent. Studies have confirmed serelaxin's haemodynamic effects of decreasing pulmonary and systemic resistance and increasing renal blood flow. A 1161-patient, placebo-controlled Phase III trial, RELAX-AHF, demonstrated significant improvement in symptoms, reduced worsening of heart failure, decreased hospital length of stay and increased 180-day survival after index hospitalisation. Additional Phase III trials (RELAX-AHF-2; RELAX-AHF-ASIA) are underway to further evaluate the efficacy of serelaxin in patients with AHF. This article will review the physiological function, mechanism of action, clinical trial results and future directions of serelaxin in the treatment of AHF.

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A Reevaluation of the Costs of Heart Failure and Its Implications for Allocation of Health Resources in the United States

Cited by 115 publications

References 32 publications

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Serelaxin and acute heart failure

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