Hospitalization for Heart Failure: A Risk for All Patients?

Heart failure continues to place heavy demands on the US health care system1:

  • About 960,000 patients are newly diagnosed with heart failure each year
  • In 2012, there were 509,000 emergency department visits for heart failure

>1 million heart failure–related hospitalizations occur each year, and rehospitalization continues to be an issue1,2

Even Mild to Moderated (NYHA class II) Patients are at High Risk of Hospitalization for Heart Failure

* EMPHASIS was a randomized, double-blind, placebo-controlled trial of 2737 patients at least 55 years of age. Patients received eplerenone (up to 50 mg daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure.3

The CHARM Low–Left Ventricular Ejection Fraction (LVEF) trials were two randomized, parallel, placebo-controlled trials (CHARM-Alternative, for patients who cannot tolerate ACE inhibitors, and CHARM-Added, for patients who were receiving ACE inhibitors). Mortality and morbidity were determined in 4576 low (≤40%) LVEF patients (2289 candesartan and 2287 placebo), titrated as tolerated to a target dose of 32 mg once daily, and observed for 2 to 4 years (median, 40 months). The primary outcome (time to first event by intention to treat) was cardiovascular death or heart failure hospitalization for each trial, in the pooled analysis of the low LVEF trials.4

Hospitalizations are the biggest driver of the direct costs associated with heart failure4

Heart failure is the number 1 cause of hospitalization among Medicare patients.6

  • ~80 % of overall heart failure hospitalizations occur among Medicare patients7

Under new Medicare rules, hospitals can be penalized for readmission rates. Please see the economic impact section for more information regarding rehospitalization penalties.

References:

  1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update; a report from the American Heart Association. [published online ahead of print January 25, 2017]. Circulation. doi:10.1161/CIR.0000000000000485.
  2. Bradley EH, Curry L, Horwitz LI, et al. Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes. 2013;6(4):444-450.
  3. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364:11-21.
  4. Young JB, Dunlap ME, Pfeffer MA, Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) Investigators and Committees. Mortality and morbidity reduction with Candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials. Circulation. 2004;110(17):2618-2626.
  5. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606-619.
  6. Wier M, Pfuntner A, Maeda J, et al. HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2009. Rockville, MD: Agency for Health Care Research and Quality, 2011. http://www.ncbi.nlm.nih.gov/books/ NBK91985. Accessed October 21, 2014.
  7. Fang J, Mensah GA, Croft JB, et al. Heart failure-related hospitalization in the U.S., 1979 to 2004. J Am Coll Cardiol. 2008;52:428–34.