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Healthcare Costs among Patients with Heart Failure: Comparisons between Decedents and Survivors Over One Year
S90 Journal of Cardiac Failure Vol. 22 No. 8S August 2016 Table. Population Metrics, TM Treatment and Matched Control Cohorts
N Avg. Age % Female % Heart Failure % COPD % HTN % Diabetes Avg. 12 month prior medical costs % IP visitation Avg. 24 month post medical costs 24 month post % IP visitation
Control
Treatment
178 74.4 57.3 85.4 48.3 94.4 45.5 $38,783
178 75.2 57.3 85.4 48.3 94.4 45.5 $40,008
95.5 $67,127
95.5 $53,518
59.6
64.0
Difference
$13,608 ($2449 , $24,768) 4.49 (−1.97,10.96)
visitation rates, driving a reduction in medical costs. In this study, we estimate a visitation rate reduction of 4.9%, and a medical cost reduction of $13,608 over 24 months.
259 Healthcare Costs among Patients with Heart Failure: Comparisons between Decedents and Survivors Over One Year Jason P. Swindle1, Engels N. Obi2, Stuart J. Turner2, Patricia A. Russo2, Chun-Lan Chang2, Cori J. Blauer-Peterson1, Lynn A. Wacha1, Aylin Altan1; 1Optum, Eden Prairie, MN; 2Novartis Pharmaceuticals Corporation, East Hanover, NJ Background: Prior research suggests increased costs in the final months of life, yet little is known about the cost differential between patients with heart failure (HF) who die or survive. Objective: This study compared healthcare costs by survival status among patients with HF. Methods: A retrospective study was conducted using medical and pharmacy claims data from a large US health plan, linked with SSA death master file data. Patients were ≥18 years with 2 medical or 1 inpatient claim(s) with ICD-9-CM diagnosis code for HF (402.x1, 404.x1, 404.x3, 428.xx). Date of earliest claim for HF during 1/1/2010-12/31/2011 was defined as the index date. Cohort assignment was based on either evidence of death within 1 year (decedents) or survival for ≥1 year (survivors)
post index. Per-patient-per-month (PPPM) and cumulative medical costs (all-cause and HF-related) were calculated from the index date up to death (for decedents) or 1 year post-index (for survivor). Cohorts were hard matched 1-to-1 based on demographic and clinical characteristics. Independent samples t-tests and Pearson’s chi-square tests were used to examine differences by cohort. Results: Among patients identified with HF, 8344 survivors were matched to decedents (59% ≥ 75 years, 50% female, 88% Medicare Advantage; mean time to death for decedents: 150 days). Compared with survivors, a larger percentage of decedents had no pharmacy claims for HF-related outpatient pharmacotherapy within 60 days post-index (42% vs. 27%; P < .001). Decedents also incurred higher all-cause medical costs (PPPM: $21,400 vs. $2663; cumulative: $60,048 vs. $32,394; both comparisons P < .001) and higher HFrelated medical costs (PPPM: $16,477 vs. $1358; cumulative: $39,052 vs. $16,519; both comparisons P < .001). Inpatient costs comprised more than half of PPPM and cumulative all-cause medical costs (≥55% for survivors, ≥76% for decedents). Conclusion: Patients with HF who died within 1 year after an index HF encounter, relative to those who survived through the first year post-index, incurred markedly higher costs within 1 year despite the much shorter post-index period; with the majority of costs attributable to hospitalizations for both patient cohorts. These findings suggest opportunities for improving outcomes in HF, considering higher use of HF-related outpatient pharmacotherapy within 60 days post-index and lower costs were seen among survivors.
260 Prevalence of Cognitive Impairment (CI) in Hospitalized Heart Failure (HF) Patients Utilizing the Mini-Cog Assessment Tool Michael Pudlo, Carl Daniel, Susan Bionat, Sayali Ketkar, Arvind Bhimaraj; Houston Methodist Hospital, Houston, TX Background: HF and CI are common medical conditions resulting in high hospital admissions and readmission rates. Both diagnoses are major healthcare problems leading to longer hospital length of stay, higher costs, and frequent readmissions. Objective: We present the prevalence of CI for patients admitted to the hospital with acute decompensated heart failure (ADHF) from a performance improvement project at our institution. Method: Three cardiology nurse practitioners (NP) formed the heart failure disease management (HFDM) service and provided a tailored assessment and intervention to patients admitted with HF including CI assessment in order to provide education with family for those with CI. The NP performed a 3-minute mini-cog assessment utilizing the standard mini-cog clock draw test (CDT) and 3-item recall test. Each word recalled was worth 1 point and the CDT was worth 2 points if completed correctly. A cutoff of < 3 points on the mini-cog assessment has been validated as a positive dementia screen and was used a positive CI score. Results: The HFDM NP saw 144 patients from December 2015 to February 2016. 136 patients had a completed mini-cog assessment documented. Nine patients seen refused to have a mini-cog assessment performed. 58% were male, 43% black with a mean age of 69 years old and an age range of 25 to 94 years. A positive cognitive deficit score of <3 points resulted in 32.4% of assessed patients evaluated. The 136 patients accounted for 347 total inpatient admissions within the hospital system within the past 4 years prior to the mini-cog assessment tool being utilized. Out of the 136 patients, 92 have a risk adjusted readmission rate of 13.64% (n = 6). Conclusion: The HFDM NP quality initiative validates that cognitive impairment with HF patients is a major contributor in hospital admissions with readmissions. 32.4% of the assessed patients has a score of < 3 points, indicating a CI. There is a continued need to assess the cognitive status of patients admitted to the hospital with HF. Further protocol care is instrumental in effective treatment of the underlying disease process for patients with a cognitive impairment. (Tables 1 and 2) Table 1. Mini-Cog Score Mini-Cog Score (0–5)
N = 136 (CI %)
0 1 2 3 4 5
N = 22 (16.2%) N = 9 (6.6%) N = 13 (9.6%) N = 14 (10.3%) N = 7 (5.1%) N = 71 (52.2%)
Table 2. Mini-Cog Score Divided into 4 Quartiles Mini-Cog Score (0–5)
0 1 2 3 4 5 Grand Total
1st Quartile
Median
3rd Quartile
4th Quartile
Age (0–57)
Age (58–69)
Age (70–80)
Age (81–95)
3 0 5 1 1 22 32 25%
3 0 2 2 2 23 32 16%
4 1 3 7 2 15 32 25%
12 8 3 4 2 11 40 58%
Grand Total
22 9 13 14 7 71 136 32%
N Avg. Age % Female % Heart Failure % COPD % HTN % Diabetes Avg. 12 month prior medical costs % IP visitation Avg. 24 month post medical costs 24 month post % IP visitation
Control
Treatment
178 74.4 57.3 85.4 48.3 94.4 45.5 $38,783
178 75.2 57.3 85.4 48.3 94.4 45.5 $40,008
95.5 $67,127
95.5 $53,518
59.6
64.0
Difference
$13,608 ($2449 , $24,768) 4.49 (−1.97,10.96)
visitation rates, driving a reduction in medical costs. In this study, we estimate a visitation rate reduction of 4.9%, and a medical cost reduction of $13,608 over 24 months.
259 Healthcare Costs among Patients with Heart Failure: Comparisons between Decedents and Survivors Over One Year Jason P. Swindle1, Engels N. Obi2, Stuart J. Turner2, Patricia A. Russo2, Chun-Lan Chang2, Cori J. Blauer-Peterson1, Lynn A. Wacha1, Aylin Altan1; 1Optum, Eden Prairie, MN; 2Novartis Pharmaceuticals Corporation, East Hanover, NJ Background: Prior research suggests increased costs in the final months of life, yet little is known about the cost differential between patients with heart failure (HF) who die or survive. Objective: This study compared healthcare costs by survival status among patients with HF. Methods: A retrospective study was conducted using medical and pharmacy claims data from a large US health plan, linked with SSA death master file data. Patients were ≥18 years with 2 medical or 1 inpatient claim(s) with ICD-9-CM diagnosis code for HF (402.x1, 404.x1, 404.x3, 428.xx). Date of earliest claim for HF during 1/1/2010-12/31/2011 was defined as the index date. Cohort assignment was based on either evidence of death within 1 year (decedents) or survival for ≥1 year (survivors)
post index. Per-patient-per-month (PPPM) and cumulative medical costs (all-cause and HF-related) were calculated from the index date up to death (for decedents) or 1 year post-index (for survivor). Cohorts were hard matched 1-to-1 based on demographic and clinical characteristics. Independent samples t-tests and Pearson’s chi-square tests were used to examine differences by cohort. Results: Among patients identified with HF, 8344 survivors were matched to decedents (59% ≥ 75 years, 50% female, 88% Medicare Advantage; mean time to death for decedents: 150 days). Compared with survivors, a larger percentage of decedents had no pharmacy claims for HF-related outpatient pharmacotherapy within 60 days post-index (42% vs. 27%; P < .001). Decedents also incurred higher all-cause medical costs (PPPM: $21,400 vs. $2663; cumulative: $60,048 vs. $32,394; both comparisons P < .001) and higher HFrelated medical costs (PPPM: $16,477 vs. $1358; cumulative: $39,052 vs. $16,519; both comparisons P < .001). Inpatient costs comprised more than half of PPPM and cumulative all-cause medical costs (≥55% for survivors, ≥76% for decedents). Conclusion: Patients with HF who died within 1 year after an index HF encounter, relative to those who survived through the first year post-index, incurred markedly higher costs within 1 year despite the much shorter post-index period; with the majority of costs attributable to hospitalizations for both patient cohorts. These findings suggest opportunities for improving outcomes in HF, considering higher use of HF-related outpatient pharmacotherapy within 60 days post-index and lower costs were seen among survivors.
260 Prevalence of Cognitive Impairment (CI) in Hospitalized Heart Failure (HF) Patients Utilizing the Mini-Cog Assessment Tool Michael Pudlo, Carl Daniel, Susan Bionat, Sayali Ketkar, Arvind Bhimaraj; Houston Methodist Hospital, Houston, TX Background: HF and CI are common medical conditions resulting in high hospital admissions and readmission rates. Both diagnoses are major healthcare problems leading to longer hospital length of stay, higher costs, and frequent readmissions. Objective: We present the prevalence of CI for patients admitted to the hospital with acute decompensated heart failure (ADHF) from a performance improvement project at our institution. Method: Three cardiology nurse practitioners (NP) formed the heart failure disease management (HFDM) service and provided a tailored assessment and intervention to patients admitted with HF including CI assessment in order to provide education with family for those with CI. The NP performed a 3-minute mini-cog assessment utilizing the standard mini-cog clock draw test (CDT) and 3-item recall test. Each word recalled was worth 1 point and the CDT was worth 2 points if completed correctly. A cutoff of < 3 points on the mini-cog assessment has been validated as a positive dementia screen and was used a positive CI score. Results: The HFDM NP saw 144 patients from December 2015 to February 2016. 136 patients had a completed mini-cog assessment documented. Nine patients seen refused to have a mini-cog assessment performed. 58% were male, 43% black with a mean age of 69 years old and an age range of 25 to 94 years. A positive cognitive deficit score of <3 points resulted in 32.4% of assessed patients evaluated. The 136 patients accounted for 347 total inpatient admissions within the hospital system within the past 4 years prior to the mini-cog assessment tool being utilized. Out of the 136 patients, 92 have a risk adjusted readmission rate of 13.64% (n = 6). Conclusion: The HFDM NP quality initiative validates that cognitive impairment with HF patients is a major contributor in hospital admissions with readmissions. 32.4% of the assessed patients has a score of < 3 points, indicating a CI. There is a continued need to assess the cognitive status of patients admitted to the hospital with HF. Further protocol care is instrumental in effective treatment of the underlying disease process for patients with a cognitive impairment. (Tables 1 and 2) Table 1. Mini-Cog Score Mini-Cog Score (0–5)
N = 136 (CI %)
0 1 2 3 4 5
N = 22 (16.2%) N = 9 (6.6%) N = 13 (9.6%) N = 14 (10.3%) N = 7 (5.1%) N = 71 (52.2%)
Table 2. Mini-Cog Score Divided into 4 Quartiles Mini-Cog Score (0–5)
0 1 2 3 4 5 Grand Total
1st Quartile
Median
3rd Quartile
4th Quartile
Age (0–57)
Age (58–69)
Age (70–80)
Age (81–95)
3 0 5 1 1 22 32 25%
3 0 2 2 2 23 32 16%
4 1 3 7 2 15 32 25%
12 8 3 4 2 11 40 58%
Grand Total
22 9 13 14 7 71 136 32%