Direct Healthcare Costs of Incident Heart Failure After Acute Coronary Syndrome

OBJECTIVES: Hospital admissions have consistently been shown to be the major component of direct healthcare costs of heart failure (HF) care. However, the economic burden of incident HF (iHF) following acute coronary syndrome (ACS) has not been studied so far.

METHODS: Observational, restrospective, population-based study based on analysis of CatSalut health database that included 83,357 patients admitted for ACS (with and without ST elevation and unstable angina) between 1st January 2012 and 31st December 2021, excluding those with previous diagnosis of HF and those who died before discharge. Mean healthcare expenditure (in €) from 12 months before ACS to 24 months after discharge was analysed and stratified according to the incidence of HF.

RESULTS: The health care expenditure of iHF(+) patients during the 12 months prior to ACS was higher than that of the iHF(-). Both groups showed an increase in healthcare expenditure immediately prior to the event: while in iHF(+) patients it increased progressively during the four months prior to the event, in iHF(-) the increase occurred mainly in the last month prior to ACS.

Total healthcare expenditure was also significantly higher in iHF(+) patients than in iHF(-) during the first 24 months after hospital discharge. In both groups, healthcare expenditure was concentrated in the first month, mainly at the expense of re-hospitalisations which accounted for 37.5% in iHF(+) and 20.7% in iHF(-), while pharmaceutical expenditure accounted for only 4.2% and 7.4%, respectively (p-value<0.05). Total healthcare expenditure decreased gradually and two years after ACS, hospitalisation expenditure accounted for 25% for iHF(+) and 31.1% for iHF(-), while pharmacy expenditure had increased to 9.1% and 14.4%, respectively, (p-value<0.05).

CONCLUSIONS: The direct health care cost of iHF(+) patients after ACS is significantly higher than that of iHF(-) patients from 12 months before the event and up to 24 months after discharge. Rehospitalisations are the main component.