title: Management of heart failure with preserved ejection fraction in a local public hospital in Hong Kong.
abstract: BACKGROUND
  Heart failure (HF) is one of the most debilitating chronic illnesses. The prevalence is expected to increase due to aging population. The current study aimed to examine the management of heart failure with preserved ejection fraction (HFpEF) including drug use pattern, direct medical cost and humanistic outcome in a local public hospital in Hong Kong.
  
  
  METHODS
  The current study adopted the retrospective observational study design. Subjects were recruited from the Heart Failure Registry of the Prince of Wales Hospital in Hong Kong between 2006 and 2008 and completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 3 designated time-points conferred eligibility. Patients with significant valvular disorder were excluded. Each patient's medical record was reviewed for 12 months after the date of admission. Heart failure related admissions, clinic visits, cardiovascular drugs, laboratory tests and diagnostic tests were documented. Costs and MLHFQ scores in patients with or without hypertension, diabetes and renal impairment were compared.
  
  
  RESULTS
  A total of 73 HFpEF patients were included. It was found that loop diuretics (93.1%, 78.1%) was the most frequently used agent for HFpEF management in both in-patient and out-patient settings. The mean 1-year direct medical cost was USD$ 19969 (1 US $ = 7.8 HK$), with in-patient ward care contributing to the largest proportion (72.2%) of the total cost. Patients with diabetes or renal impairment were associated with a higher cost of HFpEF management. Significant difference was found in the renal impairment group (median cost: USD$ 24604.2 versus USD$ 12706.8 in no impairment group, p = 0.023). The MLHFQ scores of the subjects improved significantly during the study period (p < 0.0005).
  
  
  CONCLUSIONS
  The cost of management of HFpEF was enormous and further increased in the presence of comorbidities.
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. leungwaikuenangel@yahoo.com.hk.
authors.forename: Angel W
authors.initials: AW
authors.lastname: Leung
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. cherikki@hotmail.com.
authors.forename: Cherise Y
authors.initials: CY
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. bryan.yan@cuhk.edu.hk.
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. cmyu@cuhk.edu.hk.
authors.forename: Cheuk Man
authors.initials: CM
authors.lastname: Yu
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. yylam@cuhk.edu.hk.
authors.forename: Yat Yin
authors.initials: YY
authors.lastname: Lam
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. vivianlee@cuhk.edu.hk.
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D048909:Diabetes Complications; D004180:Direct Service Costs; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D006723:Hong Kong; D006779:Hospitals, Public; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D004232:Diuretics