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ORLANDO, FLA. – In the first such analysis of the costs of
heart failure, Duke University Medical Center researchers have
found that elderly patients with the debilitating heart
disorder have health care expenditures up to three times higher
than similar patients without heart failure.

Additionally, the researchers found that patients with the
more common, but less severe, form of the disease consume
similar amounts of health care resources.

These findings are important, said Lawrence Liao, M.D., Duke
cardiologist and principal investigator of the Duke studies,
because heart failure is the only cardiovascular disease whose
incidence is increasing in the U.S. Given the aging of the
population, Liao said that national policy makers need concrete
data in deciding how to allocate scarce health care resources –
both for treatment and further research.

Liao presented the results of the Duke analysis today (Nov.
12, 2003) at the 76th annual scientific session of the American
Heart Association (AHA). His research into this issue was
supported by an AHA grant.

"This is the first study to determine the long-term
inpatient and outpatient costs of heart failure in an elderly
population," Liao said. "Even after accounting for their worse
survival and greater co-morbid illness, these patients consume
substantially more health care resources than patients without
heart failure, and these higher costs persisted through four
years of follow-up."

Heart failure is a condition marked by the inability of the
heart muscles to pump enough oxygen and nutrients in the blood
to the body's tissues. Also known as congestive heart failure,
it has many causes, including infections of the heart, coronary
artery disease, high blood pressure, previous heart attacks and
valve problems. It is estimated that 4.7 million Americans
suffer from the condition, with 400,000 new cases reported each
year. Once diagnosed with heart failure, about 50 percent of
patients will die within five years.

For his analysis, Liao consulted the National Heart Lung
Blood Institute's Cardiovascular Health Study, which gathered
detailed clinical data on 4,489 elderly Americans living in
four regions: Forsyth County, N.C., Sacramento County, Calif.,
Allegheny County, Penn., and Washington County, Maryland. By
correlating this data with Medicare claims, Liao was able to
determine the economic impact of heart failure.

Patients without heart failure had an average of $3,962 of
health care costs after one year, with $15,216 after four
years. After four years, they had on average 0.92
hospitalizations and 27.9 outpatient doctor visits.

Of the 4,489 patients, 329 patients had heart failure at the
beginning of the study, with average one-year costs of $9,545
and average four-year costs of $27,822. Additionally, 319
patients developed heart failure during the study, with
one-year costs of $20,619 and four-year costs of $43,385.

"It makes sense for the newly diagnosed patients to have
higher costs, since they tend to have more inpatient visits
early in the acute phase of their disease," Liao said. "Those
already with the disease tend to be cared for on an outpatient
basis, which can be less costly."

Those with existing heart failure had on average 2.47
hospital visits after four years, compared to 3.41 for those
who developed the disease during the study. In terms of
outpatient visits, those with existing heart failure had an
average of 34.8, compared to an average of 28.6 for those who
developed the disease during the study.

There are two types of heart failure. The most widely known
form, called systolic heart failure, is characterized by the
inability of the heart to contract strongly enough. In a more
newly recognized form of the disorder, known as diastolic heart
failure, the heart beats normally but does not fill with enough
blood. In both cases, the body is deprived of oxygen-rich
blood.

Systole is that part of the heart's pumping cycle when it
contracts and pushes blood out to the body. The diastole is
when the heart relaxes and fills with blood in preparation for
the next heart beat.

Diastolic heart failure has not been considered as serious
as the systolic form because its mortality rate is about half
that of systolic heart failure's 15 percent annual rate.
However, it is estimated that in the elderly, diastolic heart
failure is more prevalent than systolic heart failure.

After four years, patients with existing systolic heart
failure had average costs of $24,349, compared to $29,162 for
those with diastolic heart failure. In terms of patients who
developed the disease during the study, systolic heart failure
patients saws average costs of $38,303, compared to $44,623 for
those who developed diastolic heart failure.

"There are many clinical trials that have examined systolic
heart failure, while the number of trials looking at diastolic
heart is minuscule," Liao said. "These data would suggest that
in terms of its costs to the health care system, more studies
need to be conducted to better understand diastolic heart
failure."

Joining Liao in his analysis were, from Duke, James Jollis,
M.D., David Whellan, M.D., Anita Chen, Kevin Anstrom, Ph.D.,
and Kevin Schulman, M.D. Also part of the team were D. Kitzman,
M.D, Wake Forest Univ. School of Medicine, Winston-Salem, N.C.;
G. Aurigemma, M.D., University of Massachusetts Medical Center;
and J. Gottdiener, M.D., St. Francis Hospital, Roslyn, NY.