Comparison of healthcare resource utilization, medication use, and costs among heart failure patients with reduced and preserved ejection fraction
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Objectives: To compare health care resource utilization, medication use, and associated costs among heart failure (HF) patients with reduced versus preserved ejection fraction (EF). Methods: We included patients ≥ 18 years of age who had an inpatient admission with a primary discharge diagnosis of HF between October 1, 2011 and September 30, 2014 along with a recent EF measurement. Those with EF ≤ 40% were placed in the reduced EF group, and those with EF ≥ 50% were placed in the preserved EF group. Patients were excluded if they had an index length of stay (LOS) greater than 30 days, a prior heart transplant or LV atrial defibrillator. Baseline characteristics, healthcare utilization and associated costs, comorbidities, and medication use between the two groups were compared using inferential statistics and generalized linear models adjusted for clinical and demographic covariates were used to address the hypotheses, assessing the effect of EF group on utilization, costs, and medication use. Results: A total of 380 HF patients were identified (54% female; mean [SD] age: 78.1 [12.0]), of which 116 (30%) had a reduced EF and 264 (69%) had a preserved EF. Those with preserved EF had a significantly greater proportion of females (60% vs 39%, p<0.001) and were older (mean [SD]: 79.0 [10.8] vs 76.0 [12.0] years, p=0.044). After adjusting for demographics, baseline utilization, and other clinical factors, EF group was not a significant predictor of any healthcare resource utilization or cost variable. Those with reduced EF had a higher prevalence of coronary heart disease (82% vs 62%, p<0.001) and cardiomyopathy (54% vs 15%, p<0.001) compared to those with preserved EF. Depression was more prevalent in HF patients with preserved EF (22% vs 11%, p=0.014) as compared to those with reduced EF. After controlling for demographics, baseline medication use, and other clinical characteristics, HF patients with reduced EF were shown to be less likely to have use of calcium channel blockers (OR: 0.380, 95% CI: 0.181-0.800, p=0.011). Conclusion: This study demonstrated that healthcare utilization and associated costs are similar between HF patients with reduced and preserved EF, thus HF can be considered a single entity in terms of overall resource use. Findings also showed that HF patients with reduced EF have higher prevalence of coronary heart disease and cardiomyopathy, while having lower prevalence of depression. Those with reduced HF also had less use of calcium channel blockers.