OBJECTIVES: Patients hospitalized due to Worsening Heart Failure (WHF) have an increased risk of rehospitalizations and death. We aim to estimate the economic and clinical burden in French patients with reduced ejection fraction (HFrEF).

METHODS: In the SNDS database, HF patients were selected through ICD-10 code I50 in 2017. Among them, HFrEF patients were identified through a machine learning algorithm matched with a French HF registry. Patients alive on 01.01.2018 (index date) were stratified by presence or absence of hospitalization for HF in the prior 24 months. Three sub-populations were defined according to the date of the latest HF-related hospitalization: <6 months, 6 to 12 months or 12 to 24 months. Direct costs analyses were estimated over one-year post-index date in a societal perspective. Outcomes including all-cause mortality and all-causes of hospitalization were assessed by using survival curves.

RESULTS: A total of 226,747 HFrEF patients (mean age, 75.6 years; 78.8% men) were selected. The mean per capita annual cost for WHF was €15,125 versus €8,773 for no-WHF. The mean cost increased when the WFH was recent, ranging from €17,162 in WHF 0-6m to about €13,000 in WHF 6-12m as well as 12-24m. In all groups, inpatient care was the major cost driver, followed by drugs and devices costs. WHF patients had a significantly higher all-cause rehospitalizations cumulative incidence at 1 year 60.2% [59.8%-60.6%] versus 39.7% [39.5%-40%] (p<0.05) and a higher mortality rate 22.0% [21.7%-22.4%] versus 9.4% [9.2%-9.5%] than the no-WHF patients (p<0.05).

CONCLUSIONS: Economic and clinical burden is high in WHF patients especially those with recent WHF, emphasizing the need for innovative strategies to reduce hospitalization and mortality rate.