University of Mississippi Medical Center, Jackson, MS, USA.
Merck & Co., Inc., Kenilworth, NJ, USA.
Adv Ther. 2020 Sep;37(9):4015-4032. doi: 10.1007/s12325-020-01456-1. Epub 2020 Aug 6.
A worsening heart failure event (WHFE) is defined as progressively escalating heart failure signs/symptoms requiring intravenous diuretic treatment or hospitalization. No studies have compared the burden of chronic heart failure with reduced ejection fraction (HFrEF) following a WHFE versus stable disease to inform healthcare decision makers.
A retrospective study using the IBM MarketScan Commercial Database included patients younger than 65 years of age with HFrEF (one inpatient or two outpatient claims of systolic HF or one outpatient claim of systolic HF plus one outpatient claim of any HF). The first claim for HFrEF during 2016 was the index date. Patients were followed for the first 12 months after the index date (the worsening assessment period) to identify a WHFE, and for an additional 12 months or until the end of continuous enrollment (the post-worsening assessment period). Mean per patient per month (PPPM) health care resource use (HCRU) and costs were compared between patients following a WHFE and stable patients during the two periods using generalized linear models adjusting for patient characteristics.
Of 16,646 patients with chronic HFrEF, 26.8% developed a WHFE. Adjusted all-cause hospitalizations (0.16 vs. 0.02 PPPM, P < 0.0001), outpatient visits (3.54 vs. 2.73 PPPM, P < 0.0001), and emergency department visits (0.25 vs. 0.06 PPPM, P < 0.0001) were higher in patients following a WHFE than stable patients during the worsening assessment period. Similar differences in HCRU were observed between the two cohorts during the post-worsening assessment period. Mean total adjusted cost of care PPPM was $8657 in patients with HFrEF following a WHFE versus $2195 in stable patients during the worsening assessment period, and $6809 versus $2849, respectively, during the post-worsening assessment period.
HCRU and costs were significantly greater in patients with chronic HFrEF following a WHFE compared to those who remained stable, suggesting an unmet need to improve clinical and economic outcomes among these patients.
恶化的心衰事件（WHFE）定义为逐渐加重的心衰体征/症状，需要静脉利尿剂治疗或住院治疗。尚无研究比较 WHFE 后和稳定疾病时慢性射血分数降低心衰（HFrEF）的负担，以告知医疗保健决策者。
一项使用 IBM MarketScan 商业数据库的回顾性研究纳入了年龄小于 65 岁的 HFrEF 患者（一次住院或两次门诊收缩性心衰或一次门诊收缩性心衰和一次任何心衰的门诊）。2016 年的第一次 HFrEF 索赔为索引日期。在索引日期后 12 个月（恶化评估期）内对患者进行随访，以确定 WHFE，并在随后的 12 个月或直至连续入组结束（恶化后评估期）。使用广义线性模型，根据患者特征调整，比较 WHFE 后和稳定患者在两个时期内每位患者每月（PPPM）的平均医疗保健资源使用（HCRU）和成本。
在 16646 例慢性 HFrEF 患者中，26.8%发生 WHFE。调整后的全因住院治疗（0.16 与 0.02 PPPM，P<0.0001）、门诊就诊（3.54 与 0.02 PPPM，P<0.0001）和急诊就诊（0.25 与 0.06 PPPM，P<0.0001）在 WHFE 后患者中高于稳定患者在恶化评估期。在恶化后评估期，两组患者之间的 HCRU 也存在类似差异。在 WHFE 后患者中，HFrEF 的平均总调整后护理成本 PPPM 为 8657 美元，而在稳定患者中为 2195 美元，在恶化后评估期分别为 6809 美元和 2849 美元。
与稳定患者相比，WHFE 后慢性 HFrEF 患者的 HCRU 和费用显著增加，表明这些患者的临床和经济结局需要进一步改善。
