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Ong SC, Low JZ. Financial burden of heart failure in Malaysia: A perspective from the public healthcare system. PLoS One 2023; 18:e0288035. [PMID: 37406003 DOI: 10.1371/journal.pone.0288035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Estimating and evaluating the economic burden of HF and its impact on the public healthcare system is necessary for devising improved treatment plans in the future. The present study aimed to determine the economic impact of HF on the public healthcare system. METHOD The annual cost of HF per patient was estimated using unweighted average and inverse probability weighting (IPW). Unweight average estimated the annual cost by considering all observed cases regardless of the availability of all the cost data, while IPW calculated the cost by weighting against inverse probability. The economic burden of HF was estimated for different HF phenotypes and age categories at the population level from the public healthcare system perspective. RESULTS The mean (standard deviation) annual costs per patient calculated using unweighted average and IPW were USD 5,123 (USD 3,262) and USD 5,217 (USD 3,317), respectively. The cost of HF estimated using two different approaches did not differ significantly (p = 0.865). The estimated cost burden of HF in Malaysia was USD 481.9 million (range: USD 31.7 million- 1,213.2 million) per year, which accounts for 1.05% (range: 0.07%-2.66%) of total health expenditure in 2021. The cost of managing patients with heart failure with reduced ejection fraction (HFrEF) accounted for 61.1% of the total financial burden of HF in Malaysia. The annual cost burden increased from USD 2.8 million for patients aged 20-29 to USD 142.1 million for those aged 60-69. The cost of managing HF in patients aged 50-79 years contributed 74.1% of the total financial burden of HF in Malaysia. CONCLUSION A large portion of the financial burden of HF in Malaysia is driven by inpatient costs and HFrEF patients. Long-term survival of HF patients leads to an increase in the prevalence of HF, inevitably increasing the financial burden of HF.
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Affiliation(s)
- Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
| | - Joo Zheng Low
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Hospital Sultan Ismail Petra, Ministry of Health Malaysia, Kuala Krai, Kelantan, Malaysia
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Naik MG, Budde K, Koehler K, Vettorazzi E, Pigorsch M, Arkossy O, Stuard S, Duettmann W, Koehler F, Winkler S. Remote Patient Management May Reduce All-Cause Mortality in Patients With Heart-Failure and Renal Impairment. Front Med (Lausanne) 2022; 9:917466. [PMID: 35899216 PMCID: PMC9309436 DOI: 10.3389/fmed.2022.917466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 01/17/2023] Open
Abstract
BackgroundRemote patient management (RPM) in heart failure (HF) patients has been investigated in several prospective randomized trials. The Telemedical Interventional Management in Heart Failure II (TIM-HF2)-trial showed reduced all-cause mortality and hospitalizations in heart failure (HF) patients using remote patient management (RPM) vs. usual care (UC). We report the trial's results for prespecified eGFR-subgroups.MethodsTIM-HF2 was a prospective, randomized, controlled, parallel-group, unmasked (with randomization concealment), multicenter trial. A total of 1,538 patients with stable HF were enrolled in Germany from 2013 to 2017 and randomized to RPM (+UC) or UC. Using CKD-EPI-formula at baseline, prespecified subgroups were defined. In RPM, patients transmitted their vital parameters daily. The telemedical center reviewed and co-operated with the patient's General Practitioner (GP) and cardiologist. In UC, patients were treated by their GPs or cardiologist applying the current guidelines for HF management and treatment. The primary endpoint was the percentage of days lost due to unplanned cardiovascular hospitalizations or death, secondary outcomes included hospitalizations, all-cause, and cardiovascular mortality.ResultsOur sub analysis showed no difference between RPM and UC in both eGFR-subgroups for the primary endpoint (<60 ml/min/1.73 m2: 40.9% vs. 43.6%, p = 0.1, ≥60 ml/min/1.73 m2 26.5 vs. 29.3%, p = 0.36). In patients with eGFR < 60 ml/min/1.73 m2, 1-year-survival was higher in RPM than UC (89.4 vs. 84.6%, p = 0.02) with an incident rate ratio (IRR) 0.67 (p = 0.03). In the recurrent event analysis, HF hospitalizations and all-cause death were lower in RPM than UC in both eGFR-subgroups (<60 ml/min/1.73 m2: IRR 0.70, p = 0.02; ≥60 ml/min/1.73 m2: IRR 0.64, p = 0.04). In a cox regression analysis, age, NT-pro BNP, eGFR, and BMI were associated with all-cause mortality.ConclusionRPM may reduce all-cause mortality and HF hospitalizations in patients with HF and eGFR < 60 ml/min/1.73 m2. HF hospitalizations and all-cause death were lower in RPM in both eGFR-subgroups in the recurrent event analysis. Further studies are needed to investigate and confirm this finding.
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Affiliation(s)
- Marcel G. Naik
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
- *Correspondence: Marcel G. Naik
| | - Klemens Budde
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
| | - Kerstin Koehler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
| | - Eik Vettorazzi
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany
| | - Mareen Pigorsch
- Charité—Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Otto Arkossy
- Global Medical Office, Clinical and Therapeutical Governance Europe Middle East Asia, Fresenius Medical Care, Bad Homburg, Germany
| | - Stefano Stuard
- Global Medical Office, Clinical and Therapeutical Governance Europe Middle East Asia, Fresenius Medical Care, Bad Homburg, Germany
| | - Wiebke Duettmann
- Charité—Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health, Charité Medical University of Berlin, Berlin, Germany
| | - Friedrich Koehler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Gottingen, Germany
| | - Sebastian Winkler
- Charité—Universitätsmedizin Berlin, Medical Department, Division of Cardiology and Angiology, Centre for Cardiovascular Telemedicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Gottingen, Germany
- Unfallkrankenhaus Berlin, Department of Internal Medicine, Berlin, Germany
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Thyagaturu HS, Bolton AR, Li S, Kumar A, Shah KR, Katz D. Effect of Diabetes Mellitus on 30 and 90-Day Readmissions of Patients With Heart Failure. Am J Cardiol 2021; 155:78-85. [PMID: 34275590 DOI: 10.1016/j.amjcard.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
The prevalence of diabetes mellitus (DM) in hospitalized heart failure (HF) patients is increasing over time. However, the effect of DM on short-term readmissions for HF is not well established. We investigated the effects of DM on readmissions of HF patients. All adult hospitalizations with a primary diagnosis of HF were identified in the National Readmission Database (NRD) for 2018 and were categorized into those with and without a secondary diagnosis of DM. The primary outcome was to assess risk difference in 30 and 90-day all-cause readmissions. Multivariate Cox survival analysis and multivariate Cox regression were performed to estimate the readmission risk difference in HF patients with and without DM. Of 925,637 HF hospitalizations that met the inclusion criteria, 441,295 (47.6%) had concomitant DM. Diabetics hospitalized for HF had higher prevalence of obesity (37.3% vs 19.5%), kidney disease (58.4% vs 29.2%) and coronary disease (61.1% vs 51.0%), compared to HF hospitalizations without DM. In adjusted analyses, DM was associated with higher hazards for all-cause [hazards ratio (HR), 30 days: 1.04 (1.02-1.06); 90 days: 1.07 (1.05-1.09)], HF [HR, 30 days: 1.05 (1.02-1.07); 90 days: 1.08 (1.05-1.10)] and myocardial infarction (MI) [HR, 30 days: 1.26 (1.12-1.41); 90 days: 1.38 (1.25-1.52)] readmissions. In conclusion, in patients with HF-related hospitalizations, the presence of DM was associated with a higher risk of 30 and 90-day all-cause, HF and MI readmissions.
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Affiliation(s)
- Harshith S Thyagaturu
- Department of Internal Medicine and Cardiology, Bassett Medical Center, Cooperstown, New York.
| | | | - Si Li
- Department of Internal Medicine, Wright Medical Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kashyap R Shah
- Department of Internal Medicine, St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Daniel Katz
- Department of Internal Medicine and Cardiology, Bassett Medical Center, Cooperstown, New York
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Givertz MM, Yang M, Hess GP, Zhao B, Rai A, Butler J. Resource utilization and costs among patients with heart failure with reduced ejection fraction following a worsening heart failure event. ESC Heart Fail 2021; 8:1915-1923. [PMID: 33689217 PMCID: PMC8120411 DOI: 10.1002/ehf2.13155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 01/14/2023] Open
Abstract
Aims The aim of this study is to characterize healthcare resource utilization and costs in patients with heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event. Methods and results This was a retrospective observational cohort analysis. Patients with HFrEF were identified from the PINNACLE Registry and linked to a nationwide pharmacy and medical claims database. Worsening heart failure was defined as stable heart failure with a subsequent hospitalization and/or intravenous diuretic therapy. Healthcare resource use and costs in 2015 US dollars were analysed for dispensed prescriptions, outpatient encounters, and hospital encounters. Among 11 064 patients with HFrEF, 3087 (27.9%) experienced a worsening heart failure event during an average follow‐up of 973 days. During the first 30 days after the worsening event, 19.8% of patients had hospital readmissions with heart failure as the primary or secondary diagnosis. During that same time period, mean per patient heart failure‐related healthcare resource use included 1.3 prescriptions, 0.5 practitioner visits, and 0.5 hospital encounters (admissions, observations, or emergency care), for an average total medical cost of $8779 per patient including $5359 in heart failure‐related costs. During the first year following worsening heart failure onset, mean per patient total and heart failure‐related costs were $62 615 and $35 329, respectively. Conclusions The economic burden following a worsening heart failure event calls for further review of methods to prevent progressive disease, improve adherence to guideline‐directed therapy, and develop novel treatments and care strategies to moderate further progression.
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Affiliation(s)
- Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Mei Yang
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Gregory P Hess
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Bin Zhao
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Ashwin Rai
- PRA Health Sciences, Kansas City, MO, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Hakopian NN, Gharibian D, Nashed MM. Prognostic Impact of Chronic Kidney Disease in Patients with Heart Failure. Perm J 2019; 23:18.273. [PMID: 31545936 DOI: 10.7812/tpp/18.273] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Heart failure (HF) and chronic kidney disease (CKD) share many risk factors, and cardiac and renal dysfunction often coexist. The close association between HF and CKD worsens patient prognosis. OBJECTIVE To examine the association between progressing CKD with rates of hospitalization, 30-day readmission, and mortality in patients with HF. METHODS A retrospective analysis was conducted from January 1, 2012, to December 31, 2016, in the Kaiser Permanente Southern California Region. All patients age 18 years or older with a diagnosis of comorbid CKD and HF were included. Patients were excluded if they were noncontinuous members of Kaiser Permanente. Those included in the study were stratified into 2 cohorts: Early-stage CKD (stages 1, 2, and 3) and late-stage CKD (stages 4 and 5) on the basis of their estimated glomerular filtration rate in accordance with the National Kidney Foundation. RESULTS A total of 27,366 patients were identified with comorbid HF and CKD. At the first year of follow-up, patients with HF and late-stage CKD had higher all-cause hospitalization (rate ratio [RR] = 1.56, 95% confidence interval [CI] = 1.48-1.65, p < 0.001), HF-related hospitalization (RR = 1.25, 95% CI = 1.20-1.41, p = 0.001), and 30-day readmission rates (RR = 1.46, 95% CI = 1.31-1.63, p < 0.001) compared with patients with HF and early-stage CKD. In subsequent follow-up years, patients continued to have higher all-cause and HF-related hospitalization rates in late-stage CKD. The late-stage CKD cohort had a significantly higher risk of 5-year mortality (hazard ratio = 1.40, 95% CI = 1.35-1.45, p < 0.001). CONCLUSION Stage 4 and 5 CKD is a significant contributor to poor prognosis in patients with HF, leading to significantly higher rates of hospitalization, 30-day readmission, and mortality.
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Thomas MC. Perspective Review: Type 2 Diabetes and Readmission for Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818779588. [PMID: 29899670 PMCID: PMC5992798 DOI: 10.1177/1179546818779588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Abstract
Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients. In addition, agents that reduce the chances of readmission such as β-blockers, renin-angiotensin-aldosterone system blockers, and mineralocorticoid receptor antagonists are underutilised because of the perceived increased risks of adverse drug reactions and other limitations. In some cases, readmission to hospital is precipitated by acute decompensation of heart failure (re-exacerbation) leading to pulmonary congestion and/or refractory oedema. However, it appears that for most of the patients admitted and then discharged with a primary diagnosis of heart failure, most readmissions are not due to heart failure, but rather due to comorbidity including arrhythmia, infection, adverse drug reactions, and renal impairment/reduced hydration. All of these are more common in patients who also have diabetes, and all may be partly preventable. The many different reasons for readmission underline the critical value of multidisciplinary comprehensive care in patients admitted with heart failure, especially those with diabetes. A number of new strategies are also being developed to address this area of need, including the use of SGLT2 inhibitors, novel nonsteroidal mineralocorticoid antagonists, and neprilysin inhibitors.
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Affiliation(s)
- Merlin C Thomas
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Guimarães RB, Essebag V, Furlanetto M, Yanez JPG, Farina MG, Garcia D, Almeida ED, Stephan L, Lima GG, Leiria TLL. Structural heart disease as the cause of syncope. ACTA ACUST UNITED AC 2018. [PMID: 29513795 PMCID: PMC5856435 DOI: 10.1590/1414-431x20176989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001). Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001). The scores were analyzed for diagnostic performance with area under the curve (AUC) and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.
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Affiliation(s)
- R B Guimarães
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - V Essebag
- Sacre Coeur Hospital of Montreal, University of Montreal, Montreal, Quebec, Canada.,McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - M Furlanetto
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - J P G Yanez
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - M G Farina
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - D Garcia
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - E D Almeida
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - L Stephan
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - G G Lima
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - T L L Leiria
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brasil
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