Containing the Cost of Heart Failure Management

Soundarraj, Dwarakraj; Singh, Vini; Satija, Vaibhav; Thakur, Ranjan K.

doi:10.1016/j.hfc.2016.07.002

Cited by 26 publications

(25 citation statements)

References 48 publications

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“…Hospitalization is a frequent and major source of morbidity and expense for patients with heart failure and there are mandates within the medical community to identifying treatments that reduce heart failure-related hospitalizations. 1,16 Importantly, the reduction in rates of hospitalizations we observed in the CCM-REG cohort was comparable to that reported for CRT, 17 albeit in a different patient population.…”

Section: Discussionsupporting

confidence: 82%

Cardiac contractility modulation improves long‐term survival and hospitalizations in heart failure with reduced ejection fraction

Anker

Borggrefe

Neuser

et al. 2019

European J of Heart Fail

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Aims Cardiac contractility modulation (CCM) improves symptoms and exercise tolerance and reduces heart failure (HF) hospitalizations over 6‐month follow‐up in patients with New York Heart Association (NYHA) class III or IV symptoms, QRS < 130 ms and 25% ≤ left ventricular ejection fraction (LVEF) ≤ 45% (FIX‐HF‐5C study). The current prospective registry study (CCM‐REG) aimed to assess the longer‐term impact of CCM on hospitalizations and mortality in real‐world experience in this same population. Methods and results A total of 140 patients with 25% ≤ LVEF ≤ 45% receiving CCM therapy (CCM‐REG25‐45) for clinical indications were included. Cardiovascular and HF hospitalizations, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and NYHA class were assessed over 2 years. Mortality was tracked through 3 years and compared with predictions by the Seattle Heart Failure Model (SHFM). A separate analysis was performed on patients with 35% ≤ LVEF ≤ 45% (CCM‐REG35‐45) and 25% ≤ LVEF < 35% (CCM‐REG25‐34). Hospitalizations decreased by 75% (from 1.2/patient‐year the year before, to 0.35/patient‐year during the 2 years following CCM, P < 0.0001) in CCM‐REG25‐45 and by a similar amount in CCM‐REG35‐45 (P < 0.0001) and CCM‐REG25‐34. MLHFQ and NYHA class improved in all three cohorts, with progressive improvements over time (P < 0.002). Three‐year survival in CCM‐REG25‐45 (82.8%) and CCM‐REG24‐34 (79.4%) were similar to those predicted by SHFM (76.7%, P = 0.16; 78.0%, P = 0.81, respectively) and was better than predicted in CCM‐REG35‐45 (88.0% vs. 74.7%, P = 0.046). Conclusion In real‐world experience, CCM produces results similar to those of previous studies in subjects with 25% ≤ LVEF ≤ 45% and QRS < 130 ms; cardiovascular and HF hospitalizations are reduced and MLHFQ and NYHA class are improved. Overall mortality was comparable to that predicted by the SHFM but was lower than predicted in patients with 35% ≤ LVEF ≤ 45%.

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Section: Discussionsupporting

confidence: 82%

Cardiac contractility modulation improves long‐term survival and hospitalizations in heart failure with reduced ejection fraction

Anker

Borggrefe

Neuser

et al. 2019

European J of Heart Fail

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“…Hospital readmissions are common, 1 , 2 , 3 expensive, 4 , 5 and associated with adverse outcomes. Approximately 1 in 5 elderly Medicare beneficiaries are readmitted within 30 days at a cost of more than $17 billion annually, 6 making efforts to reduce readmissions a national priority.…”

mentioning

confidence: 99%

Patterns of Readmissions for Three Common Conditions Among Younger US Adults

Sukul

Sinha

Ryan

et al. 2017

The American Journal of Medicine

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Background Thirty-day readmissions among elderly Medicare patients are an important hospital quality measure. Although plans for employing 30-day readmission measures are under consideration for younger patients, little is known about readmission in younger patients or the relationship between readmissions in younger and elderly patients at the same hospital. Methods Using the 2014 Nationwide Readmissions Database, we examined readmission patterns in younger patients (18- to 64-years-old) using hierarchical models to evaluate associations between hospital 30-day risk-standardized readmission rates (RSRRs) in elderly Medicare patients and readmission risk in younger patients with acute myocardial infarction, heart failure, or pneumonia. Results There were 87,818, 98,315, and 103,251 admissions in younger patients for acute myocardial infarction, heart failure, and pneumonia, respectively, with overall 30-day unplanned readmission rates of 8.5%, 21.4%, and 13.7%. Readmission risk in younger patients was significantly associated with hospital 30-day RSRRs for elderly Medicare patients for all three conditions. A decrease in an average hospital's 30-day RSRR from the 75th percentile to the 25th percentile was associated with reduction in younger patients' risk of readmission from 8.8% to 8.0% (difference: 0.7%; 95% CI: 0.5-0.9%) for acute myocardial infarction; 21.8% to 20.0% (difference: 1.8%; 95% CI: 1.4-2.2%) for heart failure; and 13.9% to 13.1% (difference: 0.8%; 95% CI 0.5-1.0%) for pneumonia. Conclusions Among younger patients, readmission risk was moderately associated with hospital 30-day RSRR in elderly Medicare beneficiaries. Efforts to reduce readmissions among older patients may have important areas of overlap with younger patients, although further research may be necessary to identify specific mechanisms to tailor initiatives to younger patients.

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“…There aEre at least 26 million individuals with HF worldwide (Ambrosy et al, 2014 ). In Europe and the United States, the health care expenditure attributed to HF is approximately 1–3% (Cowie et al, 2014 ; Benjamin et al, 2017 ; Soundarraj et al, 2017 ). While cardiovascular mortality from HF has improved in western countries due to disease awareness and implementation of guideline-directed therapies and management (Rush et al, 2015 ; Gordin and Fonarow, 2016 ), projections including those by the American Heart Association point to a substantial increase in the HF and aging populations that will lead to direct costs of (at least) US$160 billion for the United States by 2030 (Heidenreich et al, 2013 ).…”

Section: Epidemiologymentioning

confidence: 99%

Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us

et al. 2018

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Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.

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Containing the Cost of Heart Failure Management

Cited by 26 publications

References 48 publications

Cardiac contractility modulation improves long‐term survival and hospitalizations in heart failure with reduced ejection fraction

Cardiac contractility modulation improves long‐term survival and hospitalizations in heart failure with reduced ejection fraction

Patterns of Readmissions for Three Common Conditions Among Younger US Adults

Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us

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