科研之友
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摘要
Background: Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HFwith preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype. Methods: 1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorized as HFpEF (EF >= 45%) or HFrEF (EF < 45%). Hospitalizations, primary care, medications, and DMP workload with associated costs were evaluated assessing DMP clinic-visits, telephonic contact, medication changes over 1 year using a mixture of casemix and micro-costing techniques. Results: The total average annual cost per patient was marginally higher in patients with HFrEF (sic)13,011 (12,011, 14,078) than HFpEF, (sic)12,206 (11,009, 13,518). However, emergency non-cardiovascular admission rates and average cost per patient were higher in the HFpEF vs HFrEF group (0.46 vs 0.31 per patient/12 months) & (sic)655 (318, 1073) vs (sic)584 (396, 812). In the first 3 months of the outpatient HF-DMP the HFrEF population cost more on average (sic)791 (764, 819) vs (sic)693 (660, 728). Conclusion: There are greater short-term (3-month) costs of HFrEF versus HFpEF as part of a HF-DMP following an admission. However, long-term (3-12 month) costs of HFpEF are greater because of higher non-cardiovascular rehospitalisations. As HFpEF becomes the dominant form of HF, more work is required in HF-DMPs to address prevention of non-cardiovascular rehospitalisations and to integrate hospital based HF-DMPs into primary healthcare structures.
- 出版日期2017-4-1
