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. 2022 Mar 17:9:818525.
doi: 10.3389/fcvm.2022.818525. eCollection 2022.

Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost

Héctor Bueno  1   2   3   4 , Clara Goñi  1   5 , Rafael Salguero-Bodes  1   3   4 , Beatriz Palacios  6 , Lourdes Vicent  1   4   7 , Guillermo Moreno  1   8 , Nicolás Rosillo  9 , Luis Varela  6 , Margarita Capel  6 , Juan Delgado  1   3   4 , Fernando Arribas  1   3   4 , Manuel Del Oro  5 , Carmen Ortega  5 , Jose L Bernal  5
Affiliations

Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost

Héctor Bueno et al. Front Cardiovasc Med. .

Abstract

Background: There is scarce information on patients with secondary heart failure diagnosis (sHF). We aimed to compare the characteristics, burden, and outcomes of sHF with those with primary HF diagnosis (pHF).

Methods: Retrospective, observational study on patients ≥18 years with emergency department (ED) visits during 2018 with pHF and sHF in ED or hospital (ICD-10-CM) diagnostic codes. Baseline characteristics, 30-day and 1-year mortality, readmission and re-ED visit rates, and costs were compared between sHF and pHF.

Results: Out of the 797 patients discharged home from the ED, 45.5% had sHF, and these presented lower 1-year hospitalization, re-ED visit rates, and costs. In contrast, out of the 2,286 hospitalized patients, 55% had sHF and 45% pHF. Hospitalized sHF patients had significantly (p < 0.01) greater comorbidity, lower use of recommended HF therapies, longer length of stay (10.8 ± 10.1 vs. 9.7 ± 7.9 days), and higher in-hospital and 1-year mortality (32 vs. 25.8%) with no significant differences in readmission rates and lower 1-year re-ED visit rate. Hospitalized sHF patients had higher total costs (€12,262,422 vs. €9,144,952, p < 0.001), mean cost per patient-year (€9,755 ± 13,395 vs. €8,887 ± 12,059), and average daily cost per patient.

Conclusion: Hospitalized sHF patients have a worse initial prognosis, greater use of healthcare resources, and higher costs.

Keywords: cost; heart failiure; mortality; outcome; resource utilization; secondary diagnosis.

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Conflict of interest statement

HB receives research funding from the Instituto de Salud Carlos III, Spain (PIE16/00021 and PI17/01799), Sociedad Española de Cardiología, Astra-Zeneca, Bayer, PhaseBio and Novartis; has received consulting fees from Astra-Zeneca, Novartis; and speaking fees from Novartis and MEDSCAPE-the heart.og. BP, LVa, and MC are AstraZeneca Spain employees. JB reports grant from AstraZeneca, during the conduct of the study. FA reports personal fees from Daiichi Sankyo, personal fees from Impulse Dynamics, personal fees from Medtronic, personal fees from Boston Scientific, personal fees from Bayer, personal fees from Bristol Myers Squibb, personal fees from Arrhythmia Network Technology SL/BAROSTIM, personal fees from Abbott, outside the submitted work. JD reports personal fees from Novartis, personal fees from Astra Zeneca, personal fees from Boehringer, outside the submitted work. RS-B reports other from Boston Scientific, non-financial support from Medtronic, personal fees and other from Daichii Sankyo, and other from Abbott, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Rates of in-hospital, 30-day and 1-year mortality rates, 30-day and 1-year readmission rates, and 30-day and 1-year new emergency department (ED) visits according to the type of heart failure diagnosis: primary and secondary.
FIGURE 2
FIGURE 2
The 30-day (top) and 1-year (down) composite outcomes using the COHERENT model according to the type of heart failure diagnosis: primary (left) and secondary (right). The black area represents mortality. The light green area on the left side of each figure represents the time spent in the first emergency department (ED) visit, the brown area represents the time spent in the first hospitalization, the light blue area in the top right corner represents the time spent at home. The days with one outpatient office visit, the number of days with subsequent ED visits, or the days spent in the hospital during re-hospitalizations are represented by the light yellow, dark green, and light brown areas, respectively. The proportion of time spent in each clinical condition can be compared in the display in the horizontal bars shown below.
FIGURE 3
FIGURE 3
Survival curves for hospitalized patients according to the type of heart failure diagnosis: primary and secondary.
See this image and copyright information in PMC

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