Economic burden of chronic heart failure with preserved vs. reduced ejection fraction – an analysis from the German Competence Network Heart Failure

Aim: Chronic heart failure (CHF) is currently one of the most prevalent cardiac diseases. The present analysis sought to estimate the one-year disease-related resource use and associated management costs of patients with CHF differentiated according to patients with preserved (HFpEF) and reduced ejection fraction (HFrEF). This differentiation could be used to describe patients as having systolic heart failure (HFrEF) and diastolic heart failure (HFpEF). Today, there is still paucity of data concerning cost of illness in heart failure according to these subgroups. Subject and Methods: 4,714 individuals with heart failure (mean age 64.5 years ± 13.2, 31.2% female, NYHA I-IV) were included from the German Competence Network Heart Failure. Patients with an ejection fraction (EF) of less than 50% were assigned to the HFrEF group (n = 3.530, mean age 63.7 years ± 13.2, 23.8% female, NYHA I-IV), whereas those with an EF≥50% constituted the HFpEF group (mean age 66.8 years ± 13.0, 53.3% female, NYHA I-IV). Disease-related resource use was assessed with regard to outpatient contacts to physicians, hospitalizations, rehabilitation stays, and drug utilization for a period of 12 months. Costs refer to the year 2011. Results: During one year, the entire patient population had on average 5.3 contacts to the general practitioner, 1.8 contacts to cardiologists and 0.7 hospital stays per year. The analysis showed that patients with HFrEF had a significant higher resource use compared to patients with HFpEF: The HFrEF group consulted the general practitioner with 6.1 contacts significantly more often in comparison to patients with HFpEF, who had on average 2.9 contacts to the GP (p < 0.001). A similar result was also seen in cardiologist contacts: the mean number of contacts was 2.2 in the HFrEF group and 0.7 in the HFpEF group (p < 0.001). In addition, the mean number of hospital stays was 0.9 for patients with HFrEF and 0.3 for patients with HFpEF (p < 0.001). Overall disease-related care costs per patient were calculated at 2,845 € per year, while the costs of the HFrEF group were 3.373 € and 1.271 € in the HFpEF group (p < 0.001). The largest component of total costs in the HFrEF group related to hospitalizations (2,481 €, 74%), while costs of rehabilitation (344 €, 10%), outpatient contacts (279 €, 8%), and medication (268 €, 8%) were considerably lower. The percentage distribution was nearly the same in the two subgroups of patients with HFrEF and HFpEF. Therefore, hospital admissions accounted for 74% of the total costs with 941 € in the HFpEF group, too. Costs for rehabilitation stays were 116 € (9% of the total costs) in the HFpEF group, while 9% of the total costs related to outpatient contacts (111 €), and 8% to drug utilization with 104 €. Conclusion: The present analysis demonstrates a high disease-related resource use of heart failure care. In particular, patients with reduced ejection fraction require increased resources compared to patients with preserved ejection fraction. Inpatient resources are the largest component in heart failure care, irrespective of underlying HFrEF or HFpEF. Hence, improved treatment strategies need to be developed to optimize care thus reducing hospitalization rates.