Perrone Valentina, Sangiorgi Diego, Degli Esposti Luca, Modugno Giuseppe, Dambrosio Gaetano, Diaferia Giuseppe, Delvecchio Benedetto, Dell'Orco Mario Lucio, Masullo Mara, Ancona Domenica, Deluca Giovanni, Campanile Vito, Narracci Ottavio, Nica Mihaela, Colombo Delia, Buda Stefano
CliCon, Health Economics and Outcomes Research, Ravenna.
Dipartimento di Cardiologia, Ospedale Vittorio Emanuele II, Bisceglie (BAT).
Recenti Prog Med. 2019 Jan;110(1):23-32. doi: 10.1701/3089.30819.
Heart failure (HF) is commonly reported, it is estimated to affect 10% of subjects aged over 70 years. Objectives of this study were to describe clinical and demographic characteristics of patients with HF diagnosis, to analyze therapeutic pathways and to estimate healthcare resources consumption.
Data on patients aged ≥18 years with a hospitalization discharge diagnosis of HF between 01/01/2010 and 31/12/2014 and in treatment with HF-related drugs were extracted from the administrative databases of the Italian Local Health Unit of Barletta-Andria-Trani (BT). We described the pharmacological treatment prescribed and the use of drugs in combination both at the beginning and at the end of the 12-month follow-up period. The costs analysis was conducted with the perspective of the Italian National Health System.
A total of 2 669 patients with HF were enrolled in the study, 1 960 as primary and 709 as secondary diagnosis (average age 77.0±10.4/76.5±11.1 years respectively, 49% and 55% were male, respectively). Mortality during 12 months of follow-up was 46% and 43% respectively. Mostly prescribed pharmacological treatments were diuretics (90.4% of patients with primary HF diagnosis and 79.4% of patients with secondary HF diagnosis), beta-blockers (53.7% and 58.8%, respectively) and aldosterone antagonists (57.5% and 42.5%, respectively); moreover, during the follow-up period, half of the patients presented a switch from the original therapy and 10% of the patients required an add-on. Healthcare resource consumption for patients discharged alive was € 11 872.4 for patients with primary diagnosis and € 12 493.7 for patients with secondary diagnosis of HF. Cost for hospitalizations during follow-up was around € 3 800 (32.3% of total costs) and € 3 600 (29.0% of total costs), respectively.
Our findings are in accordance with what already published, both in a National and International context, on mortality rates in HF patients and related costs for the National Healthcare System. Results from the present study highlight the under-prescriptions of ACEi/ARBs, aldosterone antagonists and beta-blockers in HF patients.
心力衰竭（HF）较为常见，据估计，70岁以上人群中有10%受其影响。本研究的目的是描述心力衰竭诊断患者的临床和人口统计学特征，分析治疗途径并估算医疗资源消耗。
从意大利巴列塔-安德里亚-特拉尼（BT）地方卫生单位的管理数据库中提取2010年1月1日至2014年12月31日期间年龄≥18岁、出院诊断为心力衰竭且正在接受心力衰竭相关药物治疗的患者数据。我们描述了在12个月随访期开始和结束时所开的药物治疗以及联合用药情况。从意大利国家卫生系统的角度进行成本分析。
本研究共纳入2669例心力衰竭患者，其中1960例为原发性诊断，709例为继发性诊断（平均年龄分别为77.0±10.4/76.5±11.1岁，男性分别占49%和55%）。随访12个月期间的死亡率分别为46%和43%。最常开具的药物治疗是利尿剂（原发性心力衰竭诊断患者中的90.4%和继发性心力衰竭诊断患者中的79.4%）、β受体阻滞剂（分别为53.7%和58.8%）以及醛固酮拮抗剂（分别为57.5%和42.5%）；此外，在随访期间，一半的患者更换了初始治疗方案，10%的患者需要加用药物。存活出院患者的医疗资源消耗，原发性诊断患者为11872.4欧元，继发性心力衰竭诊断患者为12493.7欧元。随访期间的住院费用分别约为3800欧元（占总费用的32.3%）和3600欧元（占总费用的29.0%）。
我们的研究结果与国内和国际上已发表的关于心力衰竭患者死亡率及国家医疗系统相关费用的研究结果一致。本研究结果凸显了心力衰竭患者中血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、醛固酮拮抗剂和β受体阻滞剂的处方不足。
