National Heart Centre Singapore & Duke-National University of Singapore Medical School, Singapore.
University Medical Centre, Groningen, The Netherlands.
Clin Cardiol. 2021 May;44(5):646-655. doi: 10.1002/clc.23585. Epub 2021 Mar 11.
Limited real-world data exist on healthcare resource utilization (HCRU) and associated costs of patients with heart failure (HF) with reduced ejection fraction (HFrEF) and preserved EF (HFpEF), including urgent HF visits, which are assumed to be less burdensome than HF hospitalizations (hHFs) HYPOTHESIS: This study aimed to quantify the economic burden of HFrEF and HFpEF, via a retrospective, longitudinal cohort study, using IBM® linked claims/electronic health records (Commercial and Medicare Supplemental data only).
Adult patients, indexed on HF diagnosis (ICD-10-CM: I50.x) from July 2012 through June 2018, with 6-month minimum baseline period and varying follow-up, were classified as HFrEF (I50.2x) or HFpEF (I50.3x) according to last-observed EF-specific diagnosis. HCRU/costs were assessed during follow-up.
About 109 721 HF patients (22% HFrEF, 31% HFpEF, 47% unclassified EF; median 18 months' follow-up) were identified. There were 3.2 all-cause outpatient visits per patient-month (HFrEF, 3.3; HFpEF, 3.6); 69% of patients required inpatient stays (HFrEF, 80%; HFpEF, 78%). Overall, 11% of patients experienced hHFs (HFrEF, 23%; HFpEF, 16%), 9% experienced urgent HF visits (HFrEF, 15%; HFpEF, 12%); 26% were hospitalized less than 30 days after first urgent HF visit versus 11% after first hHF. Mean monthly total direct healthcare cost per patient was $9290 (HFrEF, $11 053; HFpEF, $7482).
HF-related HCRU is substantial among contemporary real-world HF patients in US Commercial or Medicare supplemental health plans. Patients managed in urgent HF settings were over twice as likely to be hospitalized within 30 days versus those initially hospitalized, suggesting urgent HF visits are important clinical events and quality improvement targets.
目前关于射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭（HFpEF）患者的医疗资源利用（HCRU）和相关成本的真实世界数据有限，包括假设比心力衰竭住院（hHFs）负担更轻的紧急心力衰竭就诊。
本研究旨在通过回顾性纵向队列研究，使用 IBM®链接索赔/电子健康记录（仅商业和补充医疗保险数据），量化 HFrEF 和 HFpEF 的经济负担。
2012 年 7 月至 2018 年 6 月期间，索引为心力衰竭诊断（ICD-10-CM：I50.x）的成年患者，有至少 6 个月的基线期和不同的随访期，根据最后观察到的 EF 特定诊断分为 HFrEF（I50.2x）或 HFpEF（I50.3x）。在随访期间评估 HCRU/成本。
共纳入 109721 例心力衰竭患者（22%为 HFrEF，31%为 HFpEF，47%为 EF 未分类；中位随访 18 个月）。每位患者每月有 3.2 次全因门诊就诊（HFrEF 为 3.3 次，HFpEF 为 3.6 次）；69%的患者需要住院治疗（HFrEF 为 80%，HFpEF 为 78%）。总体而言，11%的患者经历了 hHFs（HFrEF 为 23%，HFpEF 为 16%），9%经历了紧急心力衰竭就诊（HFrEF 为 15%，HFpEF 为 12%）；26%的患者在首次紧急心力衰竭就诊后不到 30 天内再次住院，而首次 hHF 后住院的患者比例为 11%。每位患者每月的直接医疗总费用为 9290 美元（HFrEF 为 11053 美元，HFpEF 为 7482 美元）。
在美国商业或补充医疗保险计划中，当代真实世界心力衰竭患者的心力衰竭相关 HCRU 相当大。在紧急心力衰竭治疗中管理的患者在 30 天内再次住院的可能性是最初住院患者的两倍多，这表明紧急心力衰竭就诊是重要的临床事件和质量改进目标。
