OBJECTIVES: Heart failure (HF) is a major public health issue due to its prevalence in the western world: two to three percent of the european population have HF. To improve patient care, the Montpellier university hospital (CHU) implemented in 2014 a new organisation of HF management called “optimised pathway”.

The aim of our study was to compare costs and readmissions rates between 2013 and 2015, and to assess the new pathway impact.

METHODS: A retrospective observationnal and comparative before-after study was conducted. The clinical endpoint was the readmission rate a year after first hospitalisation for HF. CHU databases were used to characterise the patients of interest (526 and 514 for 2013 and 2015 respectively) and their stays: administrative and medico-economic database to collect relevant demographic and medical data, and cost accounting data to value the stays. Clinical and economic outcomes were measured over a one year time horizon.

RESULTS: No significant differences were found between 2013 and 2015 regarding the one year readmission rate (18.06% in 2013, 18.48% in 2015, p = 0.86). Time intervals between first hospitalisation and readmission weren’t significantly different (p = 0.18), even if a trend could be observed (114 days in 2013 vs. 142 in 2015). No significant difference were found in terms of total length of stay (p = 0.193).

Total patient care cost more in 2015 (8468€ vs. 7223€, p < 0.01), but incomes were also higher (6871€ vs. 6368€, p = 0.088), whether not enough to compensate (difference between costs and incomes for 2013 and 2015 were -855€ and -1598€ respectively, p < 0.01).

CONCLUSIONS: There is no evidence to say that the optimised pathway reduced costs and readmissions rates, but the increasing costs can’t be assigned to it either. Researches must go further to investigate the organisational changes that occurred between 2013 and 2015.