Costs associated with symptomatic systolic heart failure

Objective: To investigate whether the extent of systolic dysfunction is a u seful predictor of the costs of healthcare and social support for patients with heart failure. Design: Cross-sectional study with collection of cost data attributed to ma nage ment of heart failure in the previous year. Setting: Four primary-care practices in Scotland. Patients: Patients receiving long term therapy with loop diuretics for susp ected heart failure. Interventions: Two-dimensional and Doppler echocardiography. Main outcome measures and results: Two hypotheses were tested: (i) the prop ortion of patients incurring costs is higher in patients with abnormal left ventricular (LV) function; and (ii) the median cost per patient that incur s costs is higher in patients with abnormal LV function. Of the 226 patients in the study, 67 (30%) had abnormal systolic function. In comparison with the remaining 159 patients, they had higher healthcare c osts [pound 560 vs pound 440 per patient year (1994/1995 values)], were mor e likely to incur hospital inpatient or outpatient costs [Odds ratio (OR): 2.02; 95% confidence interval (CI): 1.06 to 3.84] and had significantly hig her primary-care costs (mean pound 292 vs pound 231 per patient year; p = 0 .02, Mann Whitney test). In contrast, they were no more likely to incur soc ial support costs (OR: 1.22; 95% CI: 0.52 to 2.86) and the mean cost of soc ial support per patient year was lower (pound 234 vs pound 373). Conclusions: Patients with objectively measured systolic dysfunction incurr ed significantly higher healthcare costs in the year before diagnosis. This suggests that treatment that improves systolic function will reduce health care costs, even in a primary-care population with relatively mild congesti ve heart failure.