Cardiorenal Events Account for Most Health Care Costs in Patients With Heart Failure

Patients with heart failure (HF) have a higher risk of cardiorenal complications, such chronic kidney disease (CKD), which poses a significant risk for all-cause mortality, according to a recent study published in Heart. Over 5 years, cardiorenal events accounted for most health care costs in the HF patient population, the study found.

“These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalizations for HF or CKD,” the study authors wrote.

It is estimated that 64 million people have HF globally. HF increases rthe isk of severe comorbidities, such as ischemic heart disease (IHD) and higher stages of CKD. Further, at least 1% to 2% of the US annual health care budget goes toward HF.

Investigators conducted the multinational and observational CardioRenal and Metabolic disease (CaReMe) HF study to understand the prevalence of HF in contemporary patients. They also conducted the study to understand the risks and costs associated with HF.

The study looked at the records of 629,440 patients across 11 participating countries who were clinically diagnosed with prevalent HF. The average patient age was 75.2 years, at least 48.8% of patients had IHD, and the most used disease-modifying treatments were beta blockers (69.3%) and renin-angiotensin-aldosterone system inhibitors (65.8%).

“Contemporary patients with heart failure in clinical practice are generally older and burdened with more comorbidities than previously reported in single country studies (routine health care settings) that are now ageing,” the study authors wrote.

Investigators found that 1% to 2% of the global adult population has HF. More than 60% of patients had mildly reduced or preserved HF, while nearly 50% also experienced kidney failure. In the current analysis, at least 49% of patients with an estimated glomerular filtration rate (eGFR) had a later-stage type of CKD (stages 3 through 5).

The risk of adverse outcomes was worse for patients with a cardiorenal diseases than those with atherosclerotic cardiovascular disease. As a result, all-cause mortality was highest among patients who had either HF or CKD—in the study population, the rate of death from HF was 13% in 1 year.

According to the investigators, most health care costs can also be attributed to cardiorenal events, “illustrating [that] high rates of repeated heart failure events and mortality following heart failure,” the study authors wrote.

Study limitations included that there were 3 countries that did not have data on HF prevalence. Additionally, the investigators could not evaluate undetected or underreported cases of HF. Further, the study does not account for factors including hypertension history, diabetes duration, smoking, and other socioeconomic and environmental factors.

“With rapidly improving treatments for heart failure, there is considerable public health potential in understanding the contemporary burden of heart failure and the importance of optimizing its management,” the investigators wrote.

Reference

Norhammar A, Bodegard J, Vanderheyden M, et al. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure. Heart. February 2023. Accessed February 14, 2023. doi: 10.1136/heartjnl-2022-321702