OBJECTIVES : To assess all-cause direct healthcare costs in patients with and without heart failure (HF) worsening post-cardiac resynchronization therapy (CRT).

METHODS : Patients age ≥18 years with ≥1 claim for CRT, no other cardiac device implantations, and continuous insurance eligibility 180 days (d) prior to (baseline period) and following (response period) first claim for CRT were identified in Optum’s de-identified Clinformatics^© Data Mart Database containing U.S. administrative claims (2007-2018). HF worsening was defined as having ≥1 claim during response period associated with: hospitalization related to congestive HF, myocardial infarction, cardiac arrest, or de novo atrial fibrillation; intensive care unit (ICU) stays; de novo ventricular tachycardia or fibrillation; mechanical ventilation or circulatory support; ultrafiltration; de novo hemodialysis; negative inotropes; intravenous diuretics or vasodilators. Patient characteristics were compared using Chi-square (categorical) or Wilcoxon-Mann-Whitney (continuous) tests. Follow-up costs were assessed for ≥90d starting on day 181 post-CRT and reported as annualized estimated amounts paid by payers.

RESULTS : Among 12,753 eligible patients (34% female, mean age 72.4 years), 4,785 (38%) had HF worsening. The most common worsening events were congestive HF hospitalizations (19%) and ICU stays (17%). During baseline, patients with worsening had higher mean Quan-Charlson Comorbidity Index (3.4 vs. 3.0, p<0.001) and monthly costs ($7,619 vs. $5,766, p<0.001). Higher proportions of patients with worsening had hypertension (84% vs 82%) or cardiac dysrhythmia (71% vs 68%), and were prescribed loop diuretics (61% vs 52%), antiplatelet agents (22% vs 19%), or cardiac glycosides (17% vs 13%, all p<0.001). Similar differences were observed during the response period. Annualized total follow-up costs were 2.0 times higher in patients with worsening than without worsening ($58,255 vs. $29,683, p<0.001).

CONCLUSIONS : Patients with HF worsening post-CRT had different baseline and response period characteristics than patients without worsening. Early identification and prevention of HF worsening may reduce economic burden in CRT patients.