What Is the Cost of Heart Failure on the Economy?

The cost of heart failure continues to rise, placing a heavy financial burden on the US economy and the health care system1

Overall, heart failure costs were approximately $31 billion in 2012—$21 billion was composed of direct costs and $10 billion was attributed to indirect costs.1

1% to 2% of total health care spending in developed countries is attributed to heart failure costs.2 With the prevalence of heart failure rising each year, the financial burden is expected to increase.1

Total lifetime cost of heart failure per patient is nearly $110,000.

*Data derived from study of heart failure patients in Minneapolis whose costs were collected from diagnosis to death. Study was conducted after a mean follow-up of nearly 5 years.2

Hospitalizations were responsible for the majority of these costs, with an average of $73,762 per person. The highest percentages of inpatient costs are attributed to2:

  • Room and board, accounting for 33% of total costs
  • Procedures and tests, accounting for nearly 20% of total costs
  • Evaluation and management, accounting for 8% of total costs

The average length of stay is 4.77 days per heart failure patient.3

Outpatient costs account for about 23% of the total direct costs, with the highest proportion due to evaluation and management and procedures. Among evaluation and management, the majority of costs were due to office visits. In fact, in 2010 there were 1.8 million office visits with a primary diagnosis of heart failure.2,4

Heart failure and Medicare costs

The burden of heart failure and its costs is particularly high for older patients, because the prevalence and incidence of heart failure increase with age.4 Furthermore, about 80% of hospitalizations for heart failure occur among elderly patients.5

Heart failure remains the number one reason for hospitalization in patients aged 65 years and older.6 In the United States, heart failure takes up more Medicare dollars than any other diagnosis.2

In a study of discharged elderly Medicare beneficiaries with a diagnosis of heart failure, within 6 months7:

  • 23% were readmitted with a primary diagnosis of heart failure
  • 49% were readmitted for any reason, including heart failure

In a separate study of Medicare readmission rates, heart failure was associated with the highest rate of 30-day readmission (27%), even higher than the other common causes of readmission in the Medicare population (ie, pneumonia, chronic obstructive pulmonary disease (COPD), psychoses).8

Readmission penalties are growing

The Hospital Readmissions Reduction Program, a component of the Affordable Care Act, is designed to reduce the frequency of rehospitalization of Medicare patients by penalizing hospitals with excessive readmission rates for certain conditions, including heart failure9:

  • Overall, about two-thirds of hospitals in the United States are expected to face penalties of up to 1% of reimbursement for Medicare patients
  • The Centers for Medicare and Medicaid Services (CMS) expects to recoup approximately $280 million from the 2217 hospitals penalized in 2013. Penalties will intensify, reaching up to 3% in 2015
  • The CMS calculated expected readmission rates for hospitalizations due to acute myocardial infarction, chronic heart failure, and pneumonia from July 2008 to June 2011. Penalties are assessed to hospitals with a higher observed readmission rate than the calculated expected rate

More information about readmission penalties can be found here.

References:

  1. 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.
  2. Dunlay SM, Shah ND, Shi Q, et al. Lifetime costs of medical care after heart failure diagnosis. Circulation. 2011;4(1):68-75.
  3. Voigt J, John MS, Taylor A, Krucoff M, Reynolds MR, Gibson CM. A reevaluation of the costs of heart failure and Its implications for allocation of health resources in the United States. Clin Cardiol. 2014;37(5):314-321.
  4. Mozaffarian D, Benjamin EJ, Go AS; for American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29-e322.
  5. Haldeman GA, Croft JB, Giles WH, Rashidee A. Hospitalization of patients with heart failure: national hospital discharge survey, 1985 to 1995. Am Heart J. 1999;137(2):352-360.
  6. Wier LM, 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. Wexler DJ, Chen J, Smith GL, et al. Predictors of costs of caring for elderly patients discharged with heart failure. Am Heart J. 2001;142(2):350-357.
  8. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418-1428.
  9. Joynt KE, Jha AK. A path forward on Medicare readmissions. N Eng J Med. 2014;368(13):1175-1177.