Abstract 20767: Is Integrated Heart Failure Care Cost effective?
Purpose: Community-based HF care is increasingly advocated although cost effectiveness is uncertain. The Service covers 180,000 older patients, supported by a hospital HF nurse (from 2000) and two community HF nurses (from 2004) allowing full integration of care of all HF patients, irrespective of age and aetiology, between hospital and community. All nurses are supervised by a hospital physician, with joint discharge planning and nurse-led follow-up.
Methods: For the period 1998–2009: age, in-patient mortality and length of stay in consecutive admissions with a primary coded diagnosis of HF were independently analysed on behalf of Department of Health (UK) and compared with UK Hospital Episode Statistics (HES). Cost effectiveness was estimated from national tariffs for uncomplicated HF admission (£211 [$295] /day). Service costs comprised three full time nurses and three physician sessions per week.
Results: From 1998–2009 the average age of patients rose from 78 to 81y. HES non-elective HF admission rate remained unchanged whilst clinic annual admission rate fell from 365 pre-integration (1999 -2004) to 286 post-integration (2005 – 2009) (Figure). In-patient mortality fell from 23% to 15%. Length of stay (los): median (8d – unchanged); average (14d – down ward trend) was similar to HES. Service cost fell from £1,036,500 ($1,492,560) in 1998 to £906,800 ($1,305,792) in 2009.
Conclusions: External analysis of an integrated HF service demonstrated reduction in emergency admissions and in-hospital mortality and a trend to reduction in los. The integrated service was at least cost neutral with increased staff cost offset by reduction in admission cost. The above average age of the population, inclusion of only primary diagnosis HF admissions (coded as uncomplicated) and lack of analysis of reduced community and hospital clinic attendance serve to underestimate cost benefit. Reduction in length of stay offers further opportunity to enhance the service.
- © 2010 by American Heart Association, Inc.