a person with heart failure looks up with their arms flung open as a hundred dollar bill flies away

The High Costs of Heart Failure

The high costs of medical care are well known. Hospitalizations, medications, and many other aspects of treatment and care, especially for people with chronic diseases, can create a real financial burden; for the patient and the healthcare system.1 The specific costs associated with stages of heart failure (HF) have not been traditionally captured. Although it has been clear that inpatient, outpatient, and total costs of care make up an increasing economic burden on the health care system.2 Several studies have now looked at healthcare costs associated with health failure, particularly in the last 6 months of life.1

Heart failure

Heart failure is a complex syndrome with physiological signs and symptoms that develop when the heart does not function properly. The term “heart failure” doesn’t mean your heart has stopped beating. It is a condition in which the heart is unable to pump enough blood through the body. HF generally refers to people with established chronic heart failure which develops slowly over a period of time. It can be caused by different factors including coronary artery disease, heart attack, or high blood pressure. Congestive heart failure can affect people of all ages, from infants to children, and adults. It is most common in people over age 65.

More people are developing heart failure as the population ages. It is an increasing burden on the health care system in terms of cost and resources.1 HF treatment continues to improve, with better medications and new technological device advances helping people to live longer. These treatments can often come with a high price tag.1

The high cost of HF

Although heart failure can be treated, it still has no cure and mortality rates are high. The 5-year survival rate remains around 50 percent.1 The studies sought to evaluate the balance between quality of life, prolonged survival, and the use of resources and associated cost burden. They looked at the high costs of care, particularly in the last months of life. Researchers were interested in stakeholder insights – how different populations feel around decision making considering the costs of disease and medication therapy management.1

HF patients tend to have increased costs in the last 2 years of life, with the most significant increase in the final 6 months.1 They particularly noted an increase in inpatient hospitalizations during the final 2 months of life. This represents a considerable use of resources. Understanding the variation in when costs occur over time can help medical professionals identify strategies for efficient care management plans for patients, especially near the end of life.2

Contributing factors

Contributing factors to HF expenses include age, general health, and the presence of comorbidities such as:1

  • Hypertension
  • Renal disease
  • Chronic pulmonary disease
  • Coronary heart disease (including myocardial infarction)
  • Atrial fibrillation (AFib)
  • Diabetes
  • Cerebrovascular disease (including stroke)

Care for HF represents a large portion of all health care costs. The expenses associated with these comorbid conditions is also an important component, especially for hypertension, the most prevalent comorbid condition. Interestingly, according to The American College of Cardiology and the American Heart Association, hypertension is the “most important modifiable risk factor for HF in the United States.”

Study results

A 2016 study looked at Medicare Advantage with Part D (MAPD) and commercial health insurance plan claims data for 500,000 Medicare Advantage enrollees and approximately 14 million commercial enrollees annually. The broad sources of the available data provided a geographically diverse sample. The final study sample included 48,026 patients who had data available for the 6 months before death. They collected data over a 5-year period from the beginning of 2009 through the end of 2013.1

Results were clear that high health care costs and high mortality rates create a substantial burden on society. Health and medical care expenses commonly rise toward the end of life. Yet there is limited understanding regarding the patterns of cost increases among patients with HF in their final months.1

Best care practices

Significant expenses for people with heart failure include hospital admissions, some of which may be preventable.1 Discussion of issues around individual prognosis, the appropriateness of specific therapies, and desires for end of life care patients should all be a part of treatment planning. Cost-savings may be achieved based on an improved allocation of resources based on improved communications between patients and their healthcare teams.2

Cardiovascular health is significantly influenced by individual behaviors. Good heart health practices combined with educational information can help reduce the incidence and severity of heart failure. Best care practices can help improve overall health and reduce high health care costs.3

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Heart-Failure.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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