Two-year outcomes and cost for heart failure patients following discharge from the hospital after an acute heart failure admission

Abstract

Background: Follow-up costs among heart failure (HF) patients place a heavy burden on healthcare. We sought to quantify follow-up costs after a HF hospitalization, as well as, length of stay (LOS), time to readmission and mortality for patients with preserved (HFpEF) versus reduced (HFrEF) left ventricular ejection fractions. Methods: We developed a retrospective cohort of consecutively admitted acutely decompensated HF patients who had at least 1 follow-up visit. We extracted baseline clinical data from electronic medical records, and collected follow-up data on number of readmissions, length of stay, mortality over a 2-year period, and cost data from our hospital's accounting system. Kaplan-Meier curves and log rank tests were used to evaluate survival and time to first readmission in the two HF groups. Results: Our study included 444 patients, of whom 224 (51%) had HFrEF. Patients with HFrEF compared to HFpEF had higher median total costs per month alive during the 2-year follow-up period ($1684 vs. $1496, p = 0.02), and median inpatient costs per month alive ($1368 vs. $991, p = 0.03). HFrEF patients had higher total mean LOS per month alive post index hospitalization discharge (1.6 vs 1 days, p = 0.003). Similarly, HF related mean LOS per month alive was higher for HFrEF patients than for HFpEF patients (1.3 vs 0.3 days, p = 0.003). Patients with HFrEF had a trend for shorter time to first readmission and survival compared to those with HFpEF. Conclusions: At 2 years following their index HF admission, patients with HFrEF have higher costs and longer LOS compared to HFpEF patients.