title: Resource utilization and cost of heart failure associated with reduced ejection fraction in Swedish patients.
abstract: OBJECTIVE
  The purpose of this study was to assess healthcare utilization and costs for heart failure patients with reduced ejection fraction (HF-REF) in Sweden.
  
  
  RESULTS
  This was a retrospective, population-based cohort study of patients diagnosed with HF-REF during a period of 18 months at 31 primary care centers in Uppsala County, Sweden. Data was obtained from computerized records from these centers, the Swedish Patient Registry, the Swedish Prescription Registry, the Cause of Death Registry, and a local echocardiography registry maintained by the Department of Physiology, Uppsala University Hospital. Main outcome measures were cardiovascular and heart-failure-related hospitalizations, outpatient visits, medication utilization, mortality (all-cause, cardiovascular, and heart-failure), and healthcare costs for HF-REF patients. During the index period, 252 heart failure patients had a left ventricular ejection fraction measurement ≤ 40% and were categorized as having HF-REF. More than half of the patients had ≥ 1 cardiovascular or heart failure-related hospitalization. On average, patients had >2 such hospitalizations annually. They also averaged ∼1 cardiovascular or heart-failure-related outpatient visit per year. All-cause mortality was high: 15.9% patients died within 1 year after the index date. The mean annual cost per patient for heart-failure-related hospitalizations was SEK 72,613 (EUR 7610). In contrast, annual prescription costs were low, on average 3% of total cost (SEK 3503, EUR 367 per patient)
  
  
  CONCLUSIONS
  The main limitations of this study include a short follow-up time and small sample size. Also, certain data were missing, such as echocardiograms (available for only 28% of patients), and information on patients' New York Heart Association (NYHA) functional class, validity period for prescriptions or the units of medication prescribed, and medication dosing. Furthermore, the overall mortality could have been under-estimated, as only the primary cause of death was included in the analysis.
  
  
  CONCLUSIONS
  The main burden associated with HF-REF is related to hospitalizations for heart-failure events. Effective treatment options that decrease hospitalization rates could reduce patients' suffering and potentially offer considerable cost savings.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Stålhammar
authors.forename: Lee
authors.initials: L
authors.lastname: Stern
authors.forename: Ragnar
authors.initials: R
authors.lastname: Linder
authors.forename: Steven
authors.initials: S
authors.lastname: Sherman
authors.forename: Rohan
authors.initials: R
authors.lastname: Parikh
authors.forename: Rinat
authors.initials: R
authors.lastname: Ariely
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wikström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013548:Sweden