Predictors for high costs of hospital care in elderly hypertensive patients.
OBJECTIVE
To analyse predictors of high cost of care in elderly hypertensive patients, in particular costs related to short-term (<10 days) and long-term (< or = 10 days) institutional care.


METHODS
Health Economy (HE) sub-study in the Swedish Trial in Old Patients with Hypertension-2 (STOP Hypertension-2).


METHODS
Outpatient clinics, hospitals and nursing homes in Sweden.


METHODS
Elderly (70-84 years) patients (n=6614) from the STOP Hypertension-2 cohort with a systolic or diastolic hypertension, or a combination thereof, were included.


METHODS
Costs of institutional care were analysed and categorized as short-term (<10 days or long-term care (> or = 10 days). Costs were related to individual patients and calculations were made during follow-up in STOP Hypertension-2 from inclusion to end of study. Data was available from 99% of all scheduled visits during the median 5.3 years of follow-up in the 6614 elderly hypertensive patients.


RESULTS
A multivariate analysis of potential predictors for inpatient short-term or long-term care demonstrated that several clinical factors within the groups of target organ damage (TOD), associated clinical conditions (ACC), as well as additional risk factors (RF) predicted for an increased probability of inpatient care in elderly hypertensives. Specifically, predictors for heart failure (OR 1.73, p=0.005), diabetes (OR 1.36, p<0.0005) and older age (OR 1.05, p<0.0001). Predictors at entry for long-term care (> or = 10 days) were; presence of ischaemic heart disease (OR 1.65, p<0.0001), diabetes mellitus (OR 1.32, p=0.012), female gender (OR 0.80, p=0.0003) as well as older age (OR 1.02, p=0.046). High total costs for this cohort of elderly hypertensive patients were recorded in the group subjected to long-term care for cardiovascular as well as non-cardiovascular reasons. Male gender (p=0.004) and stroke (p=0.06) remained predictors for high costs for hospital care while stroke (p<0.0001) and old age (p<0.0001) predicted for high costs for nursing home care.


CONCLUSIONS
In elderly hypertensives in STOP Hypertension-2, presence of cardiac disease, stroke, diabetes and older age at entry increased the probability as well as costs for both short- and long-term care. Level of systolic or diastolic blood pressure did not predict for hospitalization or cost outcome. Our results provide an economic argument for strict risk reduction focus in the management of elderly high-risk hypertensive patients.
Linjer
Erland
E
Department of Clinical Pharmacology, Sahlgrenska University Hospital, Stockholm, Sweden.
Jörnmark
Jan
J
Hedner
Thomas
T
Jönsson
Bengt
B
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000191:economics / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004232:Diuretics / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005544:Forecasting; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics*; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D012737:Sex Factors; D013548:Sweden
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004232:Diuretics