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Lawrence Liao, MD; James G. Jollis, MD; Kevin J. Anstrom, PhD; David J. Whellan, MD; Dalane W. Kitzman, MD; Gerard P. Aurigemma, MD; Daniel B. Mark, MD; Kevin A. Schulman, MD; John S. Gottdiener, MD

Arch Intern Med. 2006;166:112-118.

Background  Among the elderly population, heart failure (HF) with normal ejection fraction (EF) is more common than classic HF with low EF. However, there are few data regarding the costs of HF with normal EF. In a prospective, population-based cohort of elderly participants, we compared the costs and resource use of patients with HF and normal and reduced EF.

Methods  A total of 4549 participants (84.5% white; 40.6% male) in the National Heart, Lung, and Blood Institute Cardiovascular Health Study were linked to Medicare claims from 1992 through 1998. By protocol echo examinations or clinical EF assessments, 881 participants with HF were characterized as having abnormal or normal EF. We applied semiparametric estimators to calculate mean costs per subject for a 5-year period.

Results  There were 495 HF participants with normal EF (186 prevalent at study entry and 309 incident during the study period) and 386 participants with abnormal EF (166 prevalent and 220 incident). Participants with abnormal EF had more cardiology encounters and cardiac procedures. However, compared with abnormal EF participants, the 5-year costs for normal EF participants were similar in both the prevalent ($33 023 with abnormal EF and $32 580 with normal EF; P = .93) and incident ($49 128 with abnormal EF and $45 604 with normal EF; P = .55) groups. In models accounting for comorbid conditions, the costs with normal and abnormal EF remained similar.

Conclusions  Over a 5-year period, patients with HF and normal EF consume as many health care resources as those with reduced EF. These data highlight the substantial financial burden of HF with normal EF among the elderly population.

Author Affiliations: Duke Clinical Research Institute, Durham, NC (Drs Liao, Jollis, Anstrom, Mark, and Schulman); Jefferson Heart Institute, Philadelphia, Pa (Dr Whellan); Wake Forest University School of Medicine, Winston-Salem, NC (Dr Kitzman); University of Massachusetts Medical Center, Worcester (Dr Aurigemma); and University of Maryland School of Medicine, Baltimore (Dr Gottdiener).

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