The following is a summary of “Medical Costs of Chronic Kidney Disease and Type 2 Diabetes Among Newly Diagnosed Heart Failure Patients With Reduced, Mildly Reduced, and Preserved Ejection Fraction,” published in the July 2023 issue of the American Journal of Cardiovascular Disease by Nichols et al.

The fiscal burden of cardiac insufficiency (HF) is substantial; however, investigations on HF expenditures generally perceive the ailment as a unified entity. The researcher’s objective was to differentiate the healthcare expenses associated with patients diagnosed with HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). Researchers have identified a total of 16,516 adult patients who were diagnosed with incident heart failure and underwent an echocardiogram between the years 2005 and 2017. This information was obtained from the electronic medical record system of Kaiser Permanente Northwest. Utilizing the echocardiogram closest to the initial date of diagnosis, Researchers categorized individuals with heart failure with reduced ejection fraction (EF ≤40%), heart failure with mid-range ejection fraction (EF 41% to 49%), or heart failure with preserved ejection fraction (EF ≥50%). 

Researchers computed the annualized utilization and costs of inpatient, outpatient, emergency, and pharmaceutical medical services and the total costs for 2020. These calculations were adjusted for age and gender using generalized linear models. Additionally, Researchers conducted further analysis to examine the impact of co-morbid chronic kidney disease (CKD) and type 2 diabetes (T2D) on these factors. For all types of heart failure, 20% of patients experienced the co-occurrence of chronic kidney disease (CKD) and type 2 diabetes (T2D), resulting in significantly elevated costs when both comorbidities were present. The per-person costs were notably elevated for patients with heart failure with preserved ejection fraction (HFpEF) at $33,740 (95% confidence interval $32,944 to $34,536), which exceeded the costs for heart failure with reduced ejection fraction (HFrEF) at $27,669 ($25,649 to $29,689) or heart failure with mid-range ejection fraction (HFmrEF) at $29,484 ($27,166 to $31,800).

These higher costs were primarily attributed to both inpatient and outpatient visits. Across various types of heart failure, the number of medical visits approximately doubled when patients had the presence of both co-morbidities. As a result of its higher prevalence, heart failure with preserved ejection fraction (HFpEF) constituted the majority of overall treatment costs for heart failure, irrespective of the coexistence of chronic kidney disease (CKD) and type 2 diabetes (T2D). In summary, the financial burden was higher per patient with heart failure with preserved ejection fraction (HFpEF). It was further exacerbated by comorbid chronic kidney disease (CKD) and type 2 diabetes (T2D). Heart failure with preserved ejection fraction (HFpEF) constituted most of overall heart failure expenditures, highlighting the imperative to establish efficacious interventions.

Source: sciencedirect.com/science/article/pii/S0002914923002497