Macarena University Hospital, Dr. Fedriani nº3, 41009, Seville, Spain.
Juan Ramon Jimenez University Hospital, Huelva, Spain.
Health Qual Life Outcomes. 2021 May 8;19(1):142. doi: 10.1186/s12955-021-01779-9.
Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF).
This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient's outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data.
Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year.
A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.
心力衰竭（HF）是一个主要且日益严重的医疗和经济问题，在全球范围内具有较高的患病率和发病率。心脏生物标志物正成为一种用于改善射血分数降低的心力衰竭（HFrEF）患者管理的新工具。
这是一项干预前后的研究，评估了基于风险分层的临床模型和根据该风险进行的个性化管理的个性化 HF 随访程序对患者结局和相关护理成本的影响。共纳入并研究了 192 例患者，干预前和干预后各 192 例。主要终点是心力衰竭再入院率。次要结局比较了 ED 就诊率和生活质量改善率，通过 NYHA 评分降低的患者数量进行评估。还对这些数据进行了成本分析。
干预后入院率显著下降 19.8%（从 30.2%降至 10.4%），总住院人数减少 32 人（从 78 人降至 46 人），总住院时间减少 7 天（从 15 天降至 9 天）。ED 就诊率下降 44%（从 64 次降至 20 次）。干预后 31%的患者功能分级评分改善，而仅有 7.8%恶化。干预相关的总体节省成本为每位患者 72769 欧元（从 201189 欧元降至 128420 欧元），整个组在 1 年内节省 139717.65 欧元。
HF 患者的个性化随访带来了重要的结局获益，并节省了成本，主要是由于减少了患者住院再入院和显著降低了护理相关成本，这表明应更加关注这一高危患者群体，以最大限度地降低住院再入院风险。
