Liao Lawrence, Anstrom Kevin J, Gottdiener John S, Pappas Paul A, Whellan David J, Kitzman Dalane W, Aurigemma Gerard P, Mark Daniel B, Schulman Kevin A, Jollis James G
Duke Clinical Research Institute, Durham, NC, USA.
Am Heart J. 2007 Feb;153(2):245-52. doi: 10.1016/j.ahj.2006.11.010.
Although heart failure (HF) afflicts nearly 5 million Americans, the long-term cost of HF care has not been described previously. In a prospective, longitudinal cohort of community-dwelling elderly from 4 regions, we examined the long-term costs and resource use of elderly patients with HF.
We linked 4860 elderly participants in the National Heart, Lung, and Blood Institute Cardiovascular Health Study to Medicare part A and part B claims from 1992 to 2003. Costs were calculated from Medicare payments and discounted at 3% annually. We applied nonparametric estimators to calculate mean costs and resource use per patient for a 10-year period. To describe the relationship between patient characteristics and long-term costs, we constructed censoring-adjusted regression models.
There were 343 participants (84.8% white; 50.1% men; mean age, 78.2 years) with prevalent HF and 4517 participants without HF at study entry. Mean follow-up was 6.7 years (median, 6.4 years). The 10-year survival rates were 33% and 63% for the prevalent HF and nonprevalent HF groups (P < .001), respectively. The mean 10-year medical costs were significantly higher for the prevalent HF cohort (54,704 dollars vs 41 dollars,780, P < .001). The higher costs associated with HF were also reflected in greater resource use with more hospitalizations (P < .05) and more intensive care unit days (P < .05). Participants with HF had more physician visits (P < .05), with most of these encounters involving noncardiology physicians. However, in multivariate models, prevalent HF was not an independent predictor of higher costs.
Patients with HF consume substantially more health care resources than their elderly peers, and these higher costs persist through 10 years of follow-up. Many of these costs may be related to other comorbid conditions.
尽管心力衰竭（HF）困扰着近500万美国人，但此前尚未描述过HF护理的长期成本。在一项对来自4个地区的社区居住老年人的前瞻性纵向队列研究中，我们研究了老年HF患者的长期成本和资源使用情况。
我们将国家心肺血液研究所心血管健康研究中的4860名老年参与者与1992年至2003年的医疗保险A部分和B部分索赔记录相链接。成本根据医疗保险支付金额计算，并按每年3%的贴现率进行贴现。我们应用非参数估计器来计算每位患者10年期间的平均成本和资源使用情况。为了描述患者特征与长期成本之间的关系，我们构建了经删失调整的回归模型。
在研究开始时，有343名参与者（84.8%为白人；50.1%为男性；平均年龄78.2岁）患有HF，4517名参与者未患HF。平均随访时间为6.7年（中位数为6.4年）。患有HF和未患HF的组的10年生存率分别为33%和63%（P <.001）。患有HF的队列的平均10年医疗成本显著更高（54,704美元对41,780美元，P <.001）。与HF相关的较高成本也反映在更多的资源使用上，住院次数更多（P <.05）和重症监护病房天数更多（P <.05）。患有HF的参与者看医生的次数更多（P <.05），其中大多数就诊涉及非心脏病科医生。然而，在多变量模型中，患有HF并非成本较高的独立预测因素。
HF患者比同龄老年人消耗的医疗保健资源多得多，并且这些较高的成本在10年的随访中持续存在。其中许多成本可能与其他合并症有关。
