title: Factors associated with variations in hospital expenditures for acute heart failure in the United States.
abstract: BACKGROUND
  Relatively little contemporary data are available that describe differences in acute heart failure (AHF) hospitalization expenditures as a function of patient and hospital characteristics, especially from a population-based investigation. This study aimed to evaluate factors associated with variations in hospital expenditures for AHF in the United States.
  
  
  METHODS
  A cross-sectional analysis using discharge data from the 2011 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, was conducted. Discharges with primary International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes for AHF in adults were included. Costs were estimated by converting Nationwide Inpatient Sample charge data using the Healthcare Cost and Utilization Project Cost-to-Charge Ratio File. Discharges with highest (≥80th percentile) versus lowest (≤20th percentile) costs were compared for patient characteristics, hospital characteristics, utilization of procedures, and outcomes.
  
  
  RESULTS
  Of the estimated 1 million AHF hospital discharges, the mean cost estimates were $10,775 per episode. Younger age, higher percentage of obesity, atrial fibrillation, pulmonary disease, fluid/electrolyte disturbances, renal insufficiency, and greater number of cardiac/noncardiac procedures were observed in stays with highest versus lowest costs. Highest-cost discharges were more likely to be observed in urban and teaching hospitals. Highest-cost AHF discharges also had 5 times longer length of stay, were 9 times more costly, and had higher in-hospital mortality (5.6% vs 3.5%) compared with discharges with lowest costs (all P < .001).
  
  
  CONCLUSIONS
  Acute heart failure hospitalizations are costly. Expenditures vary markedly among AHF hospitalizations in the United States, with substantial differences in patient and hospital characteristics, procedures, and in-hospital outcomes among discharges with highest compared with lowest costs.
authors: Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonathan and Karin Fielding School of Public Health at UCLA, Los Angeles, CA.
authors: Boback
authors: B
authors: Ziaeian
authors: Novartis Pharmaceuticals Corporation, East Hanover, NJ.
authors: Puza P
authors: PP
authors: Sharma
authors: Novartis Pharmaceuticals Corporation, East Hanover, NJ.
authors: Tzy-Chyi
authors: TC
authors: Yu
authors: Novartis Pharmaceuticals Corporation, East Hanover, NJ.
authors: Katherine Waltman
authors: KW
authors: Johnson
authors: Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA. Electronic address: gfonarow@mednet.ucla.edu.
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures; D006333:Heart Failure / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
references: Manag Care Interface. 2002 May;15(5):46-52
references: 12024871
references: Int J Obes (Lond). 2014 Aug;38(8):1110-4
references: 24173404
references: Ann Intern Med. 2003 Feb 18;138(4):288-98
references: 12585826
references: Med Care. 2004 Jan;42(1):38-47
references: 14713738
references: Congest Heart Fail. 2004 Mar-Apr;10(2):76-84
references: 15073453
references: Am Heart J. 2007 Jan;153(1):74-81
references: 17174642
references: Circulation. 2007 Feb 20;115(7):928-35
references: 17309939
references: Arch Intern Med. 2008 Apr 28;168(8):847-54
references: 18443260
references: J Med Econ. 2008;11(3):397-414
references: 19450095
references: Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):33-40
references: 20123669
references: N Engl J Med. 2010 Jul 1;363(1):54-62
references: 20463333
references: Am J Cardiol. 2012 Mar 1;109(5):705-11
references: 22154317
references: Circ Heart Fail. 2012 Mar 1;5(2):167-75
references: 22414939
references: J Am Coll Cardiol. 2013 Jan 29;61(4):391-403
references: 23219302
references: Circ Heart Fail. 2013 May;6(3):606-19
references: 23616602
references: J Hosp Med. 2013 Jul;8(7):373-9
references: 23757115
references: Med Care Res Rev. 2013 Oct;70(5):542-63
references: 23715403
references: Ann Intern Med. 2013 Dec 3;159(11):746-57
references: 24297191
references: Ann Intern Med. 2003 Feb 18;138(4):273-87
references: 12585825