Patient health status and costs in heart failure: insights from the eplerenone post-acute myocardial infarction heart failure efficacy and survival study (EPHESUS).
BACKGROUND
Although a variety of prognostic tools have been shown to predict rehospitalization and mortality in heart failure patients, their utility in assessing future costs is less clear. We assessed whether health status assessment with the Kansas City Cardiomyopathy Questionnaire (KCCQ) predicts future costs in stable heart failure outpatients with left ventricular dysfunction after myocardial infarction.


RESULTS
We evaluated 12-month cost utilization data from 1516 heart failure outpatients enrolled in the Quality-of-Life Substudy of the Eplerenone Post-Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Multivariable hierarchical models assessed whether the KCCQ (categorized as 0 to <25, 25 to <50, 50 to <75, and 75 to 100) was an independent predictor of future resource use. At baseline, 685 patients (45.2%) had good health status (KCCQ scores > or =75), whereas 510 (33.6%), 262 (17.3%), and 59 (3.9%) had fair (KCCQ, 50 to 74), poor (KCCQ, 25 to 49), and the worst (KCCQ <25) health status, respectively. After multivariable adjustment, compared with patients with good health status, patients with fair health status incurred incremental 1-year costs of $1520 (cost ratio, 1.23; 95% confidence interval, 1.05 to 1.43), whereas patients with poor and the worst health status incurred incremental 1-year costs of $4265 (cost ratio, 1.63; 95% confidence interval, 1.34 to 1.99) and $8999 (cost ratio, 2.34; 95% confidence interval, 1.62 to 3.38), respectively (P<0.0001 for association with KCCQ). Further adjustment for New York Heart Association class led to only partial attenuation of this relationship (P=0.0002).


CONCLUSIONS
Health status assessment predicts resource use and costs over the next year in stable heart failure outpatients with left ventricular dysfunction after myocardial infarction.
Chan
Paul S
PS
St Luke's Mid-America Heart Institute, Kansas City, MO 64111, USA. paul1chan@yahoo.com
Soto
Gabriel
G
Jones
Philip G
PG
Nallamothu
Brahmajee K
BK
Zhang
Zefeng
Z
Weintraub
William S
WS
Spertus
John A
JA
D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D000077545:Eplerenone; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends; D006304:Health Status; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D015996:Survival Rate / Q000639:trends; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000191:economics / Q000401:mortality
D013148:Spironolactone; D000077545:Eplerenone