Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Post-Graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Clinics (Sao Paulo). 2023 Oct 28;78:100294. doi: 10.1016/j.clinsp.2023.100294. eCollection 2024.
To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept.
Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex.
From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US$ 63.26 vs. US$ 491.05).
Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.
测量巴西心力衰竭（HF）门诊患者的生活质量（QoL）和成本，以此引入基于价值的医疗保健（VBHC）概念。
这是一项横断面研究，在巴西的三家医院招募了射血分数<50%的 HF 患者。应用了两种 QoL（36 项简短健康调查问卷 [SF-36] 和明尼苏达州心力衰竭生活质量问卷 [MLHFQ]）和两种焦虑/抑郁问卷。SF-36 评分按域分层。使用时间驱动活动成本法（TDABC）计算治疗成本。结果按纽约心脏协会（NYHA）功能分类和性别分层。
2018 年 10 月至 2021 年 1 月期间，共招募了 198 名患者，中位 MLHFQ（49.5 [IQR 21.0，69.0]）和 SF-36 评分表明 QoL 较差，在更高的 NYHA 分类中更差。三分之一的患者有中度/重度抑郁和焦虑症状，女性焦虑评分较高。NYHA I 患者门诊随访的平均费用为 215 美元±238 美元，NYHA II 患者为 296 美元±399 美元，NYHA III/IV 患者为 667 美元±1012 美元。实验室/检查费用在 NYHA I 中占 30%，在 NYHA III/IV 中占 74%（63.26 美元 vs. 491.05 美元）。
巴西心力衰竭患者的生活质量较差，治疗费用较高；随着 NYHA 分类的增加，这两个指标都恶化。HF 似乎对女性的心理健康影响更大。成本增加主要与实验室/检查相关。准确和交叉的 QoL 和成本信息对于基于价值的护理和报销策略至关重要。
