Heart Failure Management in the Elderly. Focus on Health Economics and Quality of Life

Abstract: The incidence and prevalence of heart failure (HF) has increased successively over the past decade. Mortality and morbidity is high. It is the most common cause of hospitalisation in the elderly and has been estimated to account for 1-3% of health care costs in many countries. There is a need therefore, to improve care for HF patients. However, due to limited economic resources, this must be done with consideration for cost effectiveness issues. A retrospective analysis showed that readmission for HF was frequent in elderly patients and accounted for a significant proportion of the total cost for hospitalisation. Early discharge was associated with an increased risk of readmission within 30 days. A prospective study using in-depth interviews to assess compliance 30 days after discharge showed that non-compliance was common elderly HF patients. An evaluation of health-related quality of life (HRQL) in HF patients showed that HRQL was poor, compared to the general population. HRQL was more impaired in women compared to men. A prospective randomised trial of a management programme, including patient education and follow-up at an easy access, nurse outpatient clinic in HF patients showed that the programme was cost effective. Prognosis and HRQL were improved after 90 days compared to control patients. ACE inhibitors are under prescribed in HF. A health economic analysis found that increased prescription of ACE inhibitors for HF in Sweden would be cost effective. In conclusion, implementation of a management programme in HF is feasible and should be utilised in clinical practice. Inclusion of treatment guidelines in the management programme may further increase cost effectiveness.