A cost-saving strategy for inpatient management of advanced decompensated heart failure patients: the Cardiomyopathy Unit

Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure

INTRODUCTION AND AIMS

The prognosis of chronic heart failure with reduced ejection fraction (HFrEF) has been studied extensively, but factors predicting cardiac decompensation are poorly defined. Right ventricular stroke work index (RVSWI), an invasive measure of right ventricular (RV) systolic function, is a well-known prognostic marker of RV failure after left ventricular assist device insertion and after lung transplantation. Thus, the aim of this study was to assess whether there is a relationship between RVSWI, HFrEF hospital readmission due to cardiac decompensation, and prognosis.

METHODS

We prospectively enrolled 132 consecutive patients with HFrEF. Right heart catheterization was performed and RVSWI values were calculated in all patients. The relationship between RVSWI values and readmission and prognosis was analyzed.

RESULTS

During a median follow-up of 20±7 months, 33 patients were readmitted due to cardiac decompensation in the survivor group, and 18 patients died due to cardiac causes. There was no difference between patients who died and survived in terms of RVSWI values. Among patients with decompensation, mean RVSWI was significantly lower than in patients with stable HFrEF (6.0±2.2 g/m²/beat vs. 8.8±3.5 g/m²/beat, p<0.001). On correlation analysis, RVSWI was negatively correlated with NYHA functional class. RVSWI was also identified as an independent risk factor for cardiac decompensation in Cox regression survival analysis.

CONCLUSIONS

We showed that RVSWI predicts cardiac decompensation and correlates with functional class in advanced stage HFrEF. Our data suggest the value of combining information on right heart hemodynamics with assessment of RV function when defining the risk of patients with advanced HFrEF.

Patient-level costs of major cardiovascular conditions: a review of the international literature

OBJECTIVE

Robust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events.

METHODS

MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest - unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values.

RESULTS

Across the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union.

CONCLUSION

This review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed.