title: Economic impact of heart failure according to the effects of kidney failure.
abstract: OBJECTIVE
  To evaluate the use of health care resources and their cost according to the effects of kidney failure in heart failure patients during 2-year follow-up in a population setting.
  
  
  METHODS
  Observational retrospective study based on a review of medical records. The study included patients ≥ 45 years treated for heart failure from 2008 to 2010. The patients were divided into 2 groups according to the presence/absence of KF. Main outcome variables were comorbidity, clinical status (functional class, etiology), metabolic syndrome, costs, and new cases of cardiovascular events and kidney failure. The cost model included direct and indirect health care costs. Statistical analysis included multiple regression models.
  
  
  RESULTS
  The study recruited 1600 patients (prevalence, 4.0%; mean age 72.4 years; women, 59.7%). Of these patients, 70.1% had hypertension, 47.1% had dyslipidemia, and 36.2% had diabetes mellitus. We analyzed 433 patients (27.1%) with kidney failure and 1167 (72.9%) without kidney failure. Patients with kidney failure were associated with functional class III-IV (54.1% vs 40.8%) and metabolic syndrome (65.3% vs 51.9%, P<.01). The average unit cost was €10,711.40. The corrected cost in the presence of kidney failure was €14,868.20 vs €9,364.50 (P=.001). During follow-up, 11.7% patients developed ischemic heart disease, 18.8% developed kidney failure, and 36.1% developed heart failure exacerbation.
  
  
  CONCLUSIONS
  Comorbidity associated with heart failure is high. The presence of kidney failure increases the use of health resources and leads to higher costs within the National Health System.
authors.affiliation: Departamento de Planificación, Badalona Serveis Assistencials S.A., Badalona, Barcelona, Spain. Electronic address: asicras@bsa.cat.
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras Mainar
authors.affiliation: Departamento de Documentación Médica, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Navarro Artieda
authors.affiliation: Departamento Médico, Badalona Serveis Assistencials S.A., Badalona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Ibáñez Nolla
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006295:Health Resources / Q000639:trends*; D006333:Heart Failure / Q000150:complications / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000191:economics / Q000209:etiology*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology
keywords: Costes directos; Costes indirectos; Direct costs; Heart failure; Indirect costs; Insuficiencia cardiaca; Insuficiencia renal; Kidney failure; Use of resources; Uso de recursos