Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial
Abstract Aims Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care‐related costs of ambulatory HFpEF patients and the effect of spironolactone. Methods and results The ald...
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Wiley
2020-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12606 |
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| author | Djawid Hashemi Ludwig Dettmann Tobias D. Trippel Volker Holzendorf Johannes Petutschnigg Rolf Wachter Gerd Hasenfuß Burkert Pieske Antonia Zapf Frank Edelmann |
| author_facet | Djawid Hashemi Ludwig Dettmann Tobias D. Trippel Volker Holzendorf Johannes Petutschnigg Rolf Wachter Gerd Hasenfuß Burkert Pieske Antonia Zapf Frank Edelmann |
| author_sort | Djawid Hashemi |
| collection | DOAJ |
| description | Abstract Aims Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care‐related costs of ambulatory HFpEF patients and the effect of spironolactone. Methods and results The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double‐blind, placebo‐controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow‐up. We used a single‐patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities. The average annual costs per patient in this cohort came up to €1, 118 (±2,475), and the median costs were €332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO2max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs. Conclusions In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system. |
| format | Article |
| id | doaj-art-bd503cddd98f448d9e3384ef78a79247 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-bd503cddd98f448d9e3384ef78a792472025-02-03T10:25:46ZengWileyESC Heart Failure2055-58222020-06-017378679310.1002/ehf2.12606Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trialDjawid Hashemi0Ludwig Dettmann1Tobias D. Trippel2Volker Holzendorf3Johannes Petutschnigg4Rolf Wachter5Gerd Hasenfuß6Burkert Pieske7Antonia Zapf8Frank Edelmann9Department of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum Berlin GermanyDepartment of Cardiology and Pneumology University of Göttingen Göttingen GermanyDepartment of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum Berlin GermanyClinical Trial Centre University of Leipzig Leipzig GermanyDepartment of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum Berlin GermanyDZHK (German Centre for Cardiovascular Research), partner site Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University of Göttingen Göttingen GermanyDepartment of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum Berlin GermanyInstitute of Medical Biometry and Epidemiology University Medical Center Hamburg‐Eppendorf (UKE) Hamburg GermanyDepartment of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum Berlin GermanyAbstract Aims Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care‐related costs of ambulatory HFpEF patients and the effect of spironolactone. Methods and results The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double‐blind, placebo‐controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow‐up. We used a single‐patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities. The average annual costs per patient in this cohort came up to €1, 118 (±2,475), and the median costs were €332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO2max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs. Conclusions In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system.https://doi.org/10.1002/ehf2.12606Heart failureHeart failure with preserved ejection fractionEconomic costsEconomics |
| spellingShingle | Djawid Hashemi Ludwig Dettmann Tobias D. Trippel Volker Holzendorf Johannes Petutschnigg Rolf Wachter Gerd Hasenfuß Burkert Pieske Antonia Zapf Frank Edelmann Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial ESC Heart Failure Heart failure Heart failure with preserved ejection fraction Economic costs Economics |
| title | Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial |
| title_full | Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial |
| title_fullStr | Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial |
| title_full_unstemmed | Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial |
| title_short | Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial |
| title_sort | economic impact of heart failure with preserved ejection fraction insights from the aldo dhf trial |
| topic | Heart failure Heart failure with preserved ejection fraction Economic costs Economics |
| url | https://doi.org/10.1002/ehf2.12606 |
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