OBJECTIVES : The study aimed to explore differential burden of illness between systolic (SHF) and diastolic heart failure (DHF) and further examined HF-related medication effects among SHF patients.

METHODS : This was an observational retrospective cohort study using administrative claims data from a large U.S. national health insurer integrated with the Social Security Death Index. Newly-diagnosed HF patients were identified between 01/01/2010 through 06/30/2016 and grouped according to SHF or DHF diagnosis. Patients were followed for up to 4 years post-diagnosis. Treatment patterns, healthcare resource utilization (HCRU), costs and mortality were compared between SHF and DHF patients and analyzed using multivariable models.

RESULTS : The study included 46,885 SHF and 21,854 DHF patients. SHF had less HCRU vs DHF during the first year after HF diagnosis: hospital admissions (70.2% vs 82.4%, p<0.001) and ED visits (30.5% vs 39.1%, p<0.001); but higher annual all-cause ($64,154 vs $59,652, p<0.001) and HF-related costs ($39,957 vs $32,617, p<0.001). After adjusting for baseline characteristics, DHF patients had greater hospitalization risk (OR 1.62; 95% CI 1.55-1.69), however comparable adjusted costs (exponentiated estimate 1.01; 95% CI 0.99-1.02). The adjusted all-cause mortality during entire follow-up period was slightly lower in DHF than SHF (HR 0.96; 95% CI 0.93-0.99).

Multivariable analysis among SHF patients showed the benefits of receiving 1, 2, or ≥3 HF-related medication classes during the year preceding HF diagnosis in lowering hospitalization (OR 0.64, 0.55, 0.55), costs (exponentiated estimate 0.88, 0.85, 0.83) and mortality risks (HR= 0.91, 0.89, 0.89), respectively (all p-values<0.001). Of note, 21.9% SHF patients were taking no HF medication in the year following diagnosis.

CONCLUSIONS : This real-world analysis confirmed a high disease burden across all HF and documented the association of improved outcomes with recommended HF therapies in SHF. The high rate of untreated patients underscored a gap in care and provided an opportunity for intervention.