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ABSTRACTObjectivesEvidence on the economic impact of heart failure (HF) is vital in order to predict the cost-effectiveness of novel interventions. The objective was to estimate the healthcare costs of HF during the last five years of life.
MethodsAdults who died with HF in 2012/3 were identified through linked English Office of National Statistics mortality data and Clinical Practice Research Datalink (CPRD) primary care data. CPRD and linked Hospital Episode Statistics admissions data were used to estimate the cost of primary care prescriptions and primary care and hospital admission healthcare with 95% confidence intervals (CI). Generalized least squares regression was used to estimate the relationship between costs, HF diagnosis and patient characteristics.
ResultsIn the last 90 days of life of 1,555 identified patients, healthcare costs were £8,912 (95% CI £8,436-9,388)per patient, more than 90% of which were for inpatient or critical care. In the last 90 days, patients spent on average 17.8 days (95% CI 16.8-18.8) in hospital and had 8.8 (95% CI 8.4-9.1) primary care consultations. Most (59%) patients were in hospital on the day of death. Mean quarterly healthcare costs were significantly higher after diagnosis than preceding diagnosis (by £1,479, 95% CI £1,286-1,671). Younger patients and patients with higher comorbidity had higher costs.
ConclusionHealthcare costs increased sharply at the end of life and were dominated by hospital care. There is potential to save money by implementation and evaluation of interventions known to reduce HF hospitalisations, particularly at the end of life.

WOS: 000356799600005 ; PubMed ID: 25999021 ; Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to practicing physicians and nurses to manage acute heart failure in the pre-hospital and hospital setting. Criteria of hospitalization and of discharge are described. Gaps in knowledge and perspectives in the management of acute heart failure are also detailed. This consensus paper on acute heart failure might help enable contiguous practice. ; Bayer; Cardiorentis; Medicine Company; Critical Diagnostics; Novartis; Steering Committee member of Cardiorentis; TUBITAK; Medicines Company; Cornerstone Therapeutics; Otsuka; Janssen; Apex Innovations; Inte-Section Medical; Trevena; Vifor Pharma Ltd; Amgen; Servier; Abbott Vascular; Coridea; Respicardia; Swiss National Science Foundation; Swiss Heart Foundation; Cardiovascular Research Foundation Basel; 8sense; Abbott; ALERE; Brahms; Nanosphere; Roche; Siemens; University Hospital Basel; Astra Zeneca; BG medicine; Biomerieux; Lilly; Orion; Resmed; Roche Diagnostics; Ratiopharm; BMS; Boehringer-Ingelheim; Pfizer; Daiichi Sankyo; Boehinger Ingelheim; AstraZeneca; European Union ; A.M. received speaker's honoraria from Alere, Bayer, Edwards Life Sciences, The Medicines Company, Novartis, Orion, Servier, Thermofisher, Vifor Pharma and also received fee as member of advisory board and/or Steering Committee from Bayer, Cardiorentis, The Medicine Company, Critical Diagnostics.; M.B.Y. received speaker's honoraria and research fee from Novartis and received fee as Steering Committee member of Cardiorentis, and is supported by TUBITAK.; P.L. received speaker's honoraria from Beckman Coulter and Novartis and also received fees as a member of advisory board and/or Steering Committee from Bayer, Cardiorentis, The Medicines Company, Cornerstone Therapeutics, Novartis, Otsuka, Janssen, Apex Innovations, Inte-Section Medical, and Trevena.; P.P. received speaker's honoraria from Bayer, Novartis, Servier, Vifor Pharma, Amgen, Pfizer, Cardiorentis, Merck-Serono, Abbott Vascular and Respicardia and also received fee as member of advisory board and/or Steering Committee from Bayer, Cardiorentis, Novartis, Vifor Pharma Ltd, Amgen, Servier, Abbott Vascular, Coridea and Respicardia.; E.L. received consultancy fee from Novartis.; J.M. received honoraria for speaker or advisor from Abbott, Novartis, Orion, Otsuka, and Sanofi and fee as a member of Steering Committee from Corthera, Novartis, and Cardiorentis.; C.M. received research grants from the Swiss National Science Foundation and the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, 8sense, Abbott, ALERE, Brahms, Critical Diagnostics, Nanosphere, Roche, Siemens, and the University Hospital Basel, as well as speaker/consulting honoraria from Astra Zeneca, Abbott, ALERE, BG medicine, Biomerieux, Brahms, Cardiorentis, Lilly, Novartis, Pfizer, Roche, and Siemens.; V.P.H. received speaker's fee: Bayer, Orion, Resmed, Roche Diagnostics, Ratiopharm; consultation fees: Bayer, BMS, Boehringer-Ingelheim, Novartis, Pfizer, Roche Diagnostics, Servier. H.A.T. received speaker's honoraria from Daiichi Sankyo, Lilly, Medicines Company, AstraZeneca, Boehinger Ingelheim. Advisory board for Maquet Cardiovascular. Institutional research support by Maquet Cardiovascular, Teleflex, Terumo, Lilly, The Medicine Company.; G.F. has received research grants and/or has served as Committee member or Cochair of studies sponsored by Bayer, Novartis, Cardiorentis, Vifor Pharma, and the European Union.

Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies' Task forces on CVD prevention in clinical practice.2 - 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat. ; Peer reviewed