title: [Heart failure in Eastern Veneto: prevalence, hospitalization rate, adherence to guidelines and social costs].
abstract: Heart failure is a prominent problem of public health, requiring innovating methods of health services organization. Nevertheless, data are still not available on prevalence, hospitalization rate, adherence to Guidelines and social costs in the general Italian population. The necessity to identifying patients with heart failure derives from the efficacy of new therapeutic interventions in reducing morbidity and mortality. In this study we aimed to identify, in a subset of the Eastern Veneto population, patients with heart failure through a pharmacologic-epidemiologic survey. The study was divided in 5 phases: (1) identification of patients on furosemide in the year 2000 in the ASL 10 of Eastern Veneto general population, through an analysis of a specific pharmaceutic service database; (2) definition of the actual prevalence of heart failure in a casual sample of these patients, through data base belonging to general practitioners, cardiologists, or others. Diagnosis was based on the following criteria: (a) previous diagnosis of heart failure; (b) previous hospitalization for heart failure; (c) clinical evidence, with echocardiographic control in unclear cases; (3) survey of hospitalizations; (4) evaluation of adhesion to guidelines, through both databases and questionnaires; (5) analysis of the social costs of the disease, with a retrospective "bottom up" approach. From a total population of 198,000 subjects, we identified 4502 patients on furosemide. In a casual sample of 10,661 subjects we defined a prevalence of heart failure in Eastern Veneto of 1.1%, that increased to 7.1% in octagenarians. The prescription of life saving drugs was satisfactory, while rather poor was the indication to echocardiography and to cardiologic consultation. Hospitalization rate for DRG 127 was low: 2.1/1000 inhabitants/year in the general population and 12.5 /1000 inhabitants/year in patients >70 years of age. Yearly mortality was 10.3%. Social costs were elevated (15.394 Euros/patient/year), due to a relevant sanitary component (hospital 53%, drugs 28%) and particularly a to an indirect cost component. In conclusion, the assumption of furosemide lends itself as a good marker for identifying patients with heart failure. Patient identification is simple, cheap and cost-efficient, and can be easily reproduced in other regional areas.
authors.affiliation: Centro per lo scompenso cardiaco. U.O. Cardiologia-UTIC, San Dona di Piave. robertovalle@libero.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
authors.forename: Renzo
authors.initials: R
authors.lastname: Baccichetto
authors.forename: Sabrina
authors.initials: S
authors.lastname: Barro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Calderan
authors.forename: Emanuele
authors.initials: E
authors.lastname: Carbonieri
authors.forename: Maura
authors.initials: M
authors.lastname: Chinellato
authors.forename: Mario
authors.initials: M
authors.lastname: Chiatto
authors.forename: Alessandra
authors.initials: A
authors.lastname: D'Eri
authors.forename: Francesco
authors.initials: F
authors.lastname: Corazza
authors.forename: Massimo
authors.initials: M
authors.lastname: D'Atri
authors.forename: Raffaela
authors.initials: R
authors.lastname: Drigo
authors.forename: Simeone
authors.initials: S
authors.lastname: Fabris
authors.forename: Giuseppe Fabris
authors.initials: GF
authors.lastname: Gelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Lo Giudice
authors.forename: Federica
authors.initials: F
authors.lastname: Noventa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pollon
authors.forename: Paolo
authors.initials: P
authors.lastname: Santin
authors.forename: Franco
authors.initials: F
authors.lastname: Zanardi
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D019983:Guideline Adherence; D006306:Health Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011795:Surveys and Questionnaires
chemical_list: D004232:Diuretics; D005665:Furosemide