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(Circulation. 2009;119:398-407.)
© 2009 American Heart Association, Inc.

Health Services and Outcomes Research

Patient Health Status and Costs in Heart Failure

Insights From the Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS)

Paul S. Chan, MD, MSc; Gabriel Soto, MD; Philip G. Jones, MSc; Brahmajee K. Nallamothu, MD, MPH; Zefeng Zhang, MD, PhD; William S. Weintraub, MD; John A. Spertus, MD, MPH

From the Mid America Heart Institute, Kansas City, Mo (P.S.C., P.G.J., J.A.S.); Washington University School of Medicine, St Louis, Mo (G.S.); University of Michigan Medical School, Ann Arbor (B.K.N.); and Christiana Healthcare System, Newark, Del (Z.Z., W.S.W.).

Reprint requests to Paul Chan, MD, MSc, St. Luke’s Mid-America Heart Institute, 5th Floor, 4401 Wornall Rd, Kansas City, MO 64111. E-mail paul1chan{at}yahoo.com

Received May 15, 2008; accepted October 24, 2008.

Background— Although a variety of prognostic tools have been shown to predict rehospitalization and mortality in heart failure patients, their utility in assessing future costs is less clear. We assessed whether health status assessment with the Kansas City Cardiomyopathy Questionnaire (KCCQ) predicts future costs in stable heart failure outpatients with left ventricular dysfunction after myocardial infarction.

Methods and Results— We evaluated 12-month cost utilization data from 1516 heart failure outpatients enrolled in the Quality-of-Life Substudy of the Eplerenone Post–Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Multivariable hierarchical models assessed whether the KCCQ (categorized as 0 to <25, 25 to <50, 50 to <75, and 75 to 100) was an independent predictor of future resource use. At baseline, 685 patients (45.2%) had good health status (KCCQ scores 75), whereas 510 (33.6%), 262 (17.3%), and 59 (3.9%) had fair (KCCQ, 50 to 74), poor (KCCQ, 25 to 49), and the worst (KCCQ <25) health status, respectively. After multivariable adjustment, compared with patients with good health status, patients with fair health status incurred incremental 1-year costs of $1520 (cost ratio, 1.23; 95% confidence interval, 1.05 to 1.43), whereas patients with poor and the worst health status incurred incremental 1-year costs of $4265 (cost ratio, 1.63; 95% confidence interval, 1.34 to 1.99) and $8999 (cost ratio, 2.34; 95% confidence interval, 1.62 to 3.38), respectively (P<0.0001 for association with KCCQ). Further adjustment for New York Heart Association class led to only partial attenuation of this relationship (P=0.0002).

Conclusion— Health status assessment predicts resource use and costs over the next year in stable heart failure outpatients with left ventricular dysfunction after myocardial infarction.

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