title: Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.
abstract: BACKGROUND
  Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe.
  
  
  METHODS
  We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013.
  
  
  RESULTS
  Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost.
  
  
  CONCLUSIONS
  Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries.
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece. Electronic address: dimitrios_farmakis@yahoo.com.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Nadia
authors.initials: N
authors.lastname: Boubouchairopoulou
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Mareti
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Bistola
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece.
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006115:Greece; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics*; D055815:Young Adult
keywords: Cost; Heart failure; Hospitalization; NYHA