Incremental costs of high intensive care utilisation in patients hospitalised with heart failure

Abstract

Aims: Registries have reported large inter-hospital differences in intensive care unit admission rates for patients with acute heart failure, but little is known about the potential economic impact of over-admission of low-risk patients with heart failure to higher cost intensive care units. We described the variability in intensive care unit admission practices, the provision of critical care therapies, and estimated the potential national cost savings if all hospitals adopted low intensive care unit admission practices for patients admitted with heart failure. Methods: Using a national population health dataset, we identified 349,693 heart failure admission hospitalisations with a primary diagnosis of heart failure between 2007 and 2016. Hospitals were categorised as low (first quartile), medium (second and third quartile) and high (fourth quartiles) intensive care unit utilisation. Results: The mean intensive care unit admission rate was 16.4% (inter-hospital range 0.3–51%) including 5.4% in low, 14.5% in medium and 30% in high utilisation hospitals. Intensive care unit therapies in low, medium and high intensive care unit utilisation hospitals were 54.5%, 45.1% and 24.1% ( P<0.001), respectively and the inhospital mortality rate was not significantly different. The proportion of hospital costs incurred by intensive care unit care was 7.8% in low, 19.8% in medium and 28.2% in high ( P<0.001) admission hospitals. The potential cost savings of altering intensive care unit utilisation practices for patients with heart failure was CAN$234.8m over the study period. Conclusions: In a national cohort of patients hospitalised with heart failure, we observed that low intensive care unit utilisation centres had lower hospital costs with no differences in mortality rates. The development of standardised admission criteria for high-cost and high acuity intensive care unit beds could reduce costs to the healthcare system.

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

“…A multidisciplinary approach to this challenge is needed 78–80 because any benefit proven by using AHF risk stratification at ED would translate into both patient outcome and health care efficiency improvements. 81…”

Outpatient Palliative Care in Heart Failure: Underutilized?

“…Heart failure (HF) affects approximately 64.3 million people worldwide and its prevalence is increasing over time [1]. HF remains a progressive disease associated with high mortality rates, increased cost of care, significant symptom burden and impaired quality of life for both patients and caregivers [2][3][4][5][6][7]. A large literature calls for Palliative care (PC) for patients with HF, but there is limited experience in providing PC for these patients, especially in the outpatient/ambulatory setting [8].…”

East meets West on acute heart failure

“…An analysis of a large national healthcare dataset from all Canadian provinces except Quebec showed a marked variation in intensive care utilization in patients hospitalized with acute heart failure; however, without any effect on in-hospital mortality. 15 In low utilization hospitals, the costs related to intensive care were significantly lower, indicating that development of standardized intensive care unit admission criteria limiting the use of higher-cost intensive care beds to higher acuity patients with heart failure could substantially reduce costs to the healthcare system.…”