Clinical outcomes, health care resource utilization and costs by renal function in patients with heart failure.

Abstract

Introduction and objectives: Chronic kidney disease is highly prevalent in patients with heart failure (HF), increases clinical complexity, and worsens prognosis. This study quantitatively assessed the impact of renal dysfunction severity, including dialysis, on clinical outcomes, resource utilization, and costs in patients with HF.

Methods: Retrospective cohort study in adult patients with 1 emergency department visit or hospitalization with an HF diagnosis in a university hospital in 2018. One-year clinical outcomes, resources, and costs were compared with the Clinical Outcomes, Health care Resource Utilization, and Related Costs (COHERENT) model according to estimated glomerular filtration rate (eGFR) ≥ 60, 30 to 59, 15 to 29, and < 15 (including patients on dialysis) mL/min/1.73 m².

Results: Of 3274 patients with HF (median age, 84 years; 56% women), 1453 (44.4%) had eGFR ≥ 60. Lower eGFR levels were associated with higher 1-year mortality (20.4% in eGFR ≥ 60 vs 45.4% in eGFR 15 to 29; P < .001 for trend), rehospitalization, and new emergency department visits. Patients with eGFR < 15 had the highest readmission rate (50.8%; P < .001 for trend). Days out of hospital without dialysis decreased from 292 (80.0%) in eGFR ≥ 60 to 184 (50.3%) in eGFR < 15. Median cost per patient journey increased from 3960 (Q1-Q3, euro1750 to euro8410) with eGFR ≥ 60 to euro9590 (Q1-Q3, euro4140 to euro28 520; P < .001) with eGFR < 15, driven mainly by hospitalizations (84%-90% of total, except for eGFR < 15, 59.0%).

Conclusions: Renal dysfunction severity was associated with progressively worse clinical outcomes, increased health resource utilization, and higher costs in patients with HF. Strategies are needed to improve outcomes and reduce costs in patients with HF and severe chronic kidney disease.