OBJECTIVES

COVID-19 pandemic and the adoption of urgent measures for its containment have heavily affected the routine practice of healthcare providers especially in terms of follow-up of chronic patients. The aim of the present study was to estimate the consequences, in the next year, in terms of mortality and economic impact for the Italian Healthcare System of delays due to COVID-19 in the management of patients with heart failure (HF), in order to provide recommendations to decision makers on best management strategies for these patients in the future.

METHODS

A systematic literature review has been performed in May 2020 through Pubmed database to retrieve mortality rates of HF patients with and without cardiological follow-up. Separate meta-analyses have been performed in order to combine data for both groups. A random-effect model was applied assuming that the true effect size varies among the studies. A test on the summary effect measure has been reported, as well as a test for heterogeneity quantified by I². Concerning the economic evaluation, the healthcare spending of HF patients in their last year of life, including DRG tariffs and cost of drugs, was quantified in 10,238€ per patient, as reported by a study conducted in Italy.

RESULTS

Starting from 2,362 identified papers, the analysis focused on 4 of them reporting data on mortality. Mortality at 1 year was 19.3% (CI95% 17.1-21.6%, I²=85%) and 27.5% (CI95% 21.8-33.6%, I²=97%) for patients with and without cardiological follow-up, respectively. Heterogeneity among the studies has been confirmed. Considering only the difference in mortality, the estimated additional cost for the management of a patient with HF with delayed follow-up was 840€ (range 20-1,689€) over a time horizon of 1 year.

CONCLUSIONS

The restoration of an adequate cardiological follow-up for HF patients after the COVID-19 period may reduce mortality and costs in the following year.