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Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study.
Tuesday,2012-11-06 12:08 America/Los_Angeles — eenright
| Title | Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2007 |
| Authors | Liao, L, Anstrom, KJ, Gottdiener, JS, Pappas, PA, Whellan, DJ, Kitzman, DW, Aurigemma, GP, Mark, DB, Schulman, KA, Jollis, JG |
| Journal | Am Heart J |
| Volume | 153 |
| Issue | 2 |
| Pagination | 245-52 |
| Date Published | 2007 Feb |
| ISSN | 1097-6744 |
| Keywords | Aged, Costs and Cost Analysis, Female, Health Resources, Heart Failure, Humans, Male, Medicare, Prospective Studies, Time Factors |
| Abstract | <p><b>BACKGROUND: </b>Although heart failure (HF) afflicts nearly 5 million Americans, the long-term cost of HF care has not been described previously. In a prospective, longitudinal cohort of community-dwelling elderly from 4 regions, we examined the long-term costs and resource use of elderly patients with HF.</p><p><b>METHODS: </b>We linked 4860 elderly participants in the National Heart, Lung, and Blood Institute Cardiovascular Health Study to Medicare part A and part B claims from 1992 to 2003. Costs were calculated from Medicare payments and discounted at 3% annually. We applied nonparametric estimators to calculate mean costs and resource use per patient for a 10-year period. To describe the relationship between patient characteristics and long-term costs, we constructed censoring-adjusted regression models.</p><p><b>RESULTS: </b>There were 343 participants (84.8% white; 50.1% men; mean age, 78.2 years) with prevalent HF and 4517 participants without HF at study entry. Mean follow-up was 6.7 years (median, 6.4 years). The 10-year survival rates were 33% and 63% for the prevalent HF and nonprevalent HF groups (P < .001), respectively. The mean 10-year medical costs were significantly higher for the prevalent HF cohort (54,704 dollars vs 41 dollars,780, P < .001). The higher costs associated with HF were also reflected in greater resource use with more hospitalizations (P < .05) and more intensive care unit days (P < .05). Participants with HF had more physician visits (P < .05), with most of these encounters involving noncardiology physicians. However, in multivariate models, prevalent HF was not an independent predictor of higher costs.</p><p><b>CONCLUSION: </b>Patients with HF consume substantially more health care resources than their elderly peers, and these higher costs persist through 10 years of follow-up. Many of these costs may be related to other comorbid conditions.</p> |
| DOI | 10.1016/j.ahj.2006.11.010 |
| Alternate Journal | Am Heart J |
| PubMed ID | 17239685 |
| Grant List | R37 AG018915 / AG / NIA NIH HHS / United States N01-HC-15103 / HC / NHLBI NIH HHS / United States N01-HC-85079-85086 / HC / NHLBI NIH HHS / United States |