title: Long term health care consumption and cost expenditure in systolic heart failure.
abstract: BACKGROUND
  The prevalence, health care consumption, and mortality increase in elderly patients with heart failure. This study aimed to analyse long term cost expenditure and predictors of health care consumption in these patients.
  
  
  METHODS
  We included 208 patients aged 60 years or older and hospitalised with heart failure (NYHA class II-IV and left ventricular systolic dysfunction); 58% were men, mean age 76 years, and mean ejection fraction 0.34. Data on all hospital admissions, discharge diagnoses, lengths of stay, and outpatient visits were collected from the National Board of Health and Welfare. We obtained data of all health care consumption for each individual.
  
  
  RESULTS
  After 8-12 years of prospective follow up 72% were dead (median survival 4.6 years). Main drivers of health care expenditure were non-cardiac (40%) and cardiac (29%) hospitalizations, and visits to primary care centres (16%), and hospital outpatient clinics (15%). On average, health care expenditures were € 36,447 per patient during follow up. The average yearly cost per patient was about 5,700€, in contrast to the estimated consumption of primary and hospital care in the general population: € 1,956 in 65-74 year olds and € 2,701 in 75-84 year olds. Poor quality of life (Nottingham Health Profile) was the strongest independent predictor of total health care consumption and costs (p<0.001; by multivariate analyses).
  
  
  CONCLUSIONS
  Health care costs in chronic systolic heart failure are at least two-fold higher than in the general population. Quality of life is a strong independent predictor of health care consumption.
authors.affiliation: Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden. maritmejhert@hotmail.com
authors.forename: Märit
authors.initials: M
authors.lastname: Mejhert
authors.forename: Peter
authors.initials: P
authors.lastname: Lindgren
authors.forename: Owe
authors.initials: O
authors.lastname: Schill
authors.forename: Magnus
authors.initials: M
authors.lastname: Edner
authors.forename: Hans
authors.initials: H
authors.lastname: Persson
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D054143:Heart Failure, Systolic / Q000191:economics* / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D012720:Severity of Illness Index; D016019:Survival Analysis; D013548:Sweden
chemical_list: D002317:Cardiovascular Agents