An Economic Evaluation of a Self-Care Intervention in Persons With Heart Failure and Diabetes

Reilly, Carolyn Miller; Butler, Javed; Culler, Steven D.; Gary, Rebecca; Higgins, Melinda; Schindler, Peter; Butts, Brittany; Dunbar, Sandra B.

doi:10.1016/j.cardfail.2015.06.382

Cited by 18 publications

(17 citation statements)

References 34 publications

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“…However, transitional care typically continues for at most 3-months after hospital discharge, which risks readmission if self-care is not mastered and/or comorbid conditions are not stabilised during that period. Although interventions for specific disease combinations have been tested (e.g., HF and diabetes) [ 64 – 67 ], clinical guidelines integrating the care of multiple conditions are rare. [ 68 ].…”

Section: A Step-wise Approach To Improve Health Outcomes (Arise-hfmentioning

confidence: 99%

Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Stewart

Riegel

Boyd

et al. 2016

International Journal of Cardiology

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Background Multimorbidity in heart failure (HF), defined as HF of any aetiology and multiple concurrent conditions that require active management, represents an emerging problem within the ageing HF patient population worldwide. Methods To inform this position paper, we performed: 1) an initial review of the literature identifying the ten most common conditions, other than hypertension and ischaemic heart disease, complicating the management of HF (anaemia, arrhythmias, cognitive dysfunction, depression, diabetes, musculoskeletal disorders, renal dysfunction, respiratory disease, sleep disorders and thyroid disease) and then 2) a review of the published literature describing the association between HF with each of the ten conditions. From these data we describe a clinical framework, comprising five key steps, to potentially improve historically poor health outcomes in this patient population. Results We identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner: 1) Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomes, 2) Routinely profile (using a standardised protocol — adapted to the local health care system) all patients hospitalised with HF to determine the extent of concurrent multimorbidity, 3) Identify individualised priorities and person-centred goals based on the extent and nature of multimorbidity, 4) Support individualised, home-based, multidisciplinary, case management to supplement standard HF management, and 5) Evaluate health outcomes well beyond acute hospitalisation and encompass all-cause events and a person-centred perspective in affected individuals. Conclusions We propose ARISE-HF as a framework for improving typically poor health outcomes in those affected by multimorbidity in HF.

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Section: A Step-wise Approach To Improve Health Outcomes (Arise-hfmentioning

confidence: 99%

Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Stewart

Riegel

Boyd

et al. 2016

International Journal of Cardiology

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“…The majority of papers ( n = 16) focused on management interventions as opposed to treatment ( n = 4) for HF. Management interventions included the following: nurse led [ 17 , 19 – 26 ], telemonitoring [ 27 , 28 ], outpatient clinic based [ 15 ], person-centred care [ 16 , 18 ], exercise training [ 29 ] and NT-proBNP-guided therapy [ 30 ]. Treatment interventions included cardiac resynchronisation therapy [ 11 – 13 ] and peritoneal dialysis [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen papers reported average participant ages of > 60 years. Three papers excluded participants based on age: those aged under 21 (with an age limit of 82) [ 26 ], under 40 [ 27 ] and under 60 years [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most participants were assigned to NYHA class II (47.5%) and III (43.7%) rather than class IV (the most severe; 6.9%) or class I (asymptomatic; 1.9%). Overall, eight reports had exclusion criteria in relation to participant NYHA class, with five studies excluding NYHA class I [ 22 , 25 , 26 , 29 , 30 ] and CARE-HF (three reports) excluded NYHA class I and II [ 11 – 13 ].…”

Section: Resultsmentioning

confidence: 99%

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Valuing health-related quality of life in heart failure: a systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost–utility analyses

et al. 2019

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The accurate measurement of health-related quality of life (HRQoL) and the value of improving it for patients are essential for deriving quality-adjusted life years (QALYs) to inform treatment choice and resource allocation. The objective of this review was to identify and describe the approaches used to measure and value change in HRQoL in trial-based economic evaluations of heart failure interventions which derive QALYs as an outcome. Three databases (PubMed, CINAHL, Cochrane) were systematically searched. Twenty studies reporting economic evaluations based on 18 individual trials were identified. Most studies ( n = 17) utilised generic preference-based measures to describe HRQoL and derive QALYs, commonly the EQ-5D-3L. Of these, three studies (from the same trial) also used mapping from a condition-specific to a generic measure. The remaining three studies used patients’ direct valuation of their own health or physician-reported outcomes to derive QALYs. Only 7 of the 20 studies reported significant incremental QALY gains. Most interventions were reported as being likely to be cost-effective at specified willingness to pay thresholds. The substantial variation in the approach applied to derive QALYs in the measurement of and value attributed to HRQoL in heart failure requires further investigation.

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“…43 For example, several studies have been designed and tested with informal caregivers of individuals with heart failure 13,[62][63][64][86][87][88][89] and stroke, [90][91][92] with some including cost analyses or estimated costs of intervention delivery. 93,94 Scientific guidelines recommend that informal caregivers be included in the care of individuals with CVD, 86,90,95 yet implementation of evidence-based strategies to support informal caregivers remains a challenge in today's healthcare system, primarily because of a lack of allocated resources within healthcare systems.…”

Section: Future Research Opportunities and Policy Implications Researmentioning

confidence: 99%

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Dunbar¹,

Khavjou²,

Bakas³

et al. 2018

Circulation

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197

102

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INTRODUCTION:In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. METHODS:We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. RESULTS:The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. CONCLUSIONS:The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.

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An Economic Evaluation of a Self-Care Intervention in Persons With Heart Failure and Diabetes

Cited by 18 publications

References 34 publications

Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Valuing health-related quality of life in heart failure: a systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost–utility analyses

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

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