Clinical and Economic Burden of Chronic Heart Failure and Reduced Ejection Fraction Following a Worsening Heart Failure Event

Abstract

Introduction A worsening heart failure event (WHFE) is defined as progressively escalating heart failure signs/symptoms requiring intravenous diuretic treatment or hospitalization. No studies have compared the burden of chronic heart failure with reduced ejection fraction (HFrEF) following a WHFE versus stable disease to inform healthcare decision makers. Methods A retrospective study using the IBM ® MarketScan ® Commercial Database included patients younger than 65 years of age with HFrEF (one inpatient or two outpatient claims of systolic HF or one outpatient claim of systolic HF plus one outpatient claim of any HF). The first claim for HFrEF during 2016 was the index date. Patients were followed for the first 12 months after the index date (the worsening assessment period) to identify a WHFE, and for an additional 12 months or until the end of continuous enrollment (the post-worsening assessment period). Mean per patient per month (PPPM) health care resource use (HCRU) and costs were compared between patients following a WHFE and stable patients during the two periods using generalized linear models adjusting for patient characteristics. Results Of 16,646 patients with chronic HFrEF, 26.8% developed a WHFE. Adjusted all-cause hospitalizations (0.16 vs. 0.02 PPPM, P < 0.0001), outpatient visits (3.54 vs. 2.73 PPPM, P < 0.0001), and emergency department visits (0.25 vs. 0.06 PPPM, P < 0.0001) were higher in patients following a WHFE than stable patients during the worsening assessment period. Similar differences in HCRU were observed between the two cohorts during the post-worsening assessment period. Mean total adjusted cost of care PPPM was $8657 in patients with HFrEF following a WHFE versus $2195 in stable patients during the worsening assessment period, and $6809 versus $2849, respectively, during the post-worsening assessment period. Conclusion HCRU and costs were significantly greater in patients with chronic HFrEF following a WHFE compared to those who remained stable, suggesting an unmet need to improve clinical and economic outcomes among these patients. Electronic supplementary material The online version of this article (10.1007/s12325-020-01456-1) contains supplementary material, which is available to authorized users.

Quality outcomes, healthcare resource utilization and costs in Medicare patients with chronic heart failure with reduced ejection fraction with and without a worsening event

“…Adjusted HFrelated hospitalizations were similarly 2.5 times higher in FFS and 3.4 times higher in MA patients with chronic HFrEF following a WHFE compared to those without WHFE. These results are consistent with several previously published studies demonstrating the disease A c c e p t e d M a n u s c r i p t burden in patients who develop worsening heart failure [3,4,17,18]. Adjusted total costs and spending within categories were also higher among patients with chronic HFrEF following a WHFE compared to those without WHFE.…”

“…Adjusted total costs and spending within categories were also higher among patients with chronic HFrEF following a WHFE compared to those without WHFE. Higher healthcare resources utilization and costs in patients with chronic HFrEF following a WHFE compared to those without WHFE is consistent with results reported by Butler et. al.…”

“…MA plans are important to evaluate due to their rapid growth as a proportion of the Medicare population, now representing more than one-third of all Medicare beneficiaries [14]. In contrast to FFS claims data that have been studied for decades, MA data has not been available; thus, until now, little has been known about this The higher rates of WHFE in this study-34% in FFS and 33% in MA-could be due to Medicare beneficiaries being older on average with more comorbidities [3,4]. Adjusted HFrelated hospitalizations were similarly 2.5 times higher in FFS and 3.4 times higher in MA patients with chronic HFrEF following a WHFE compared to those without WHFE.…”

“…HFrEF is a progressive condition, and a subset of HFrEF patients experience a worsening HF event (WHFE) characterized by escalating symptoms requiring treatment in an outpatient or inpatient setting [3][4][5][6][7][8]. There is evidence that WHFE is associated with poor prognosis, worse clinical outcomes, and higher healthcare resource utilization (e.g., hospitalizations and readmissions) that generate substantially higher treatment-related costs [3][4][5][6][7][8]. Among patients with chronic HFrEF following a WHFE, readmission rates are high, with 56% of patients readmitted within 30 days of a WHFE [3].…”

Contemporary economic burden in a real‐world heart failure population with Commercial and Medicare supplemental plans

“…HCRU and costs have been reported to be significantly greater in patients with chronic HFrEF after a worsening HF event versus patients who remain stable. 10 This study, undertaken to quantify the real-world economic burden of these subgroups in the US, adds to those findings and provides a more comprehensive insight into clinical profiles, HCRU, and direct medical costs of patients with HFrEF and HFpEF.…”