title: A comparison of HFrEF vs HFpEF's clinical workload and cost in the first year following hospitalization and enrollment in a disease management program.
abstract: BACKGROUND
  Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HF with preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype.
  
  
  METHODS
  1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorized as HFpEF (EF≥45%) or HFrEF (EF<45%). Hospitalizations, primary care, medications, and DMP workload with associated costs were evaluated assessing DMP clinic-visits, telephonic contact, medication changes over 1year using a mixture of casemix and micro-costing techniques.
  
  
  RESULTS
  The total average annual cost per patient was marginally higher in patients with HFrEF €13,011 (12,011, 14,078) than HFpEF, €12,206 (11,009, 13,518). However, emergency non-cardiovascular admission rates and average cost per patient were higher in the HFpEF vs HFrEF group (0.46 vs 0.31 per patient/12months) & €655 (318, 1073) vs €584 (396, 812). In the first 3months of the outpatient HF-DMP the HFrEF population cost more on average €791 (764, 819) vs €693 (660, 728).
  
  
  CONCLUSIONS
  There are greater short-term (3-month) costs of HFrEF versus HFpEF as part of a HF-DMP following an admission. However, long-term (3-12month) costs of HFpEF are greater because of higher non-cardiovascular rehospitalisations. As HFpEF becomes the dominant form of HF, more work is required in HF-DMPs to address prevention of non-cardiovascular rehospitalisations and to integrate hospital based HF-DMPs into primary healthcare structures.
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: T M
authors.initials: TM
authors.lastname: Murphy
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: D F
authors.initials: DF
authors.lastname: Waterhouse
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: James
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Casey
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Fitzgerald
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: O'Connell
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland; Centre for Experimental Medicine, Queen's University Belfast, Northern Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Watson
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Gallagher
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Ledwidge
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland. Electronic address: kenneth.mcdonald@ucd.ie.
authors.forename: K
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D009660:Northern Ireland; D015397:Program Evaluation; D013318:Stroke Volume / Q000502:physiology*; D016526:Workload
keywords: Cost analysis; Disease management programme; HFpEF; HFrEF; Heart failure