Recently, two papers were published in peer reviewed journals on the annual direct costs for treating heart failure in the United States. One paper estimated the costs to be $21 billion and the other, published by me and my colleagues at Harvard and Duke, estimated the costs to be $60 billion. Which is it and why is this important?
First, let’s outline the differences in order to understand what this number is made up of. In the first paper, appearing in Circulation: Heart Failure, the estimates are based off self-reports from patients with the heart failure condition; their spending was on insurance, how much they spent in out-of pocket costs, and where provider-related costs came from: inpatient visits, emergency room admissions, outpatient physician office visits, home health and nursing home visits, and prescription drug costs.
The $60 billion number, cited in a Clinical Cardiology analysis, also includes these costs but adjusts them for misdiagnosis by using a methodology published by WD Rosamond in Circulation: Heart Failure in 2012.
Heart failure is a commonly misdiagnosed condition by physicians and especially by patients, and is commonly missed when present—a false negative in diagnostic terms. Rosamond’s article emphasizes this. Relying on inaccurate information in order to make policy decisions is what is commonly called “garbage in—garbage out.”
Why heart failure specialists continue to rely on bad information is a mystery and hurts their cause. Hurting their cause goes to the heart of why this is important. Heart failure is one of the leading conditions for readmission within 30 days after discharge to hospitals, the most expensive setting for treating heart failure, and slashing readmissions has become a focus of Medicare.
Care outside of the hospital, along with therapies and technologies that can be used to help reduce hospital readmissions, help cut the costs of treating heart failure. There are a number of technologies and therapies under development to identify heart failure patients early on, or presymptomatically, so that patients avoid hospital admission.
Heart failure is a condition that commonly results in patients “drowning in their own fluids.” It happens when the heart cannot pump efficiently and the lungs become filled with fluid. This results in a hospital admission.
Step one in the process to reform how we treat the condition is to agree that heart failure is a more expensive condition than what has popularly been reported in the literature—previously published information even admits this. Understanding the costs of treating heart failure can only benefit heart failure specialists as more resources can be allocated to address this very expensive condition.