Evolution of economic burden of heart failure by ejection fraction in newly diagnosed patients in Spain

Objective To describe healthcare resource utilization (HCRU) and costs, in patients with newly diagnosed heart failure (HF) according to ejection fraction (EF) in Spain. Methods Retrospective cohort study that analyzed anonymized, integrated and computerised medical records in Spain. Patients with ≥ 1 new HF diagnosis between January 2013 and September 2019 were included and followed-up during a 4-year period. Rates per 100 person-years of HCRU and costs were estimated. Results Nineteen thousand nine hundred sixty-one patients were included, of whom 43.5%, 26.3%, 5.1% and 25.1% had HF with reduced, preserved, mildly reduced and unknown EF, respectively. From year 1 to 4, HF rates of outpatient visits decreased from 1149.5 (95% CI 1140.8–1159.3) to 765.5 (95% CI 745.9–784.5) and hospitalizations from 61.7 (95% CI 60.9–62.7) to 15.7(14.7–16.7) per 100 person-years. The majority of HF-related healthcare resource costs per patient were due to hospitalizations (year 1–4: 63.3–38.2%), followed by indirect costs (year 1–4: 12.2–29.0%), pharmacy (year 1–4: 11.9–19.9%), and outpatient care (year 1–4: 12.6–12.9%). Mean (SD) per patient HF-related costs decreased from 2509.6 (3518.5) to 1234.6 (1534.1) Euros (50% cost reduction). At baseline, 70.1% were taking beta-blockers, 56.3% renin-angiotensin system inhibitors, 11.8% mineralocorticoid receptor antagonists and 8.9% SGLT2 inhibitors. At 12 months, these numbers were 72.3%, 65.4%, 18.9% and 9.8%, respectively. Conclusions Although the economic burden of HF decreased over time since diagnosis, it is still substantial. This reduction could be partially related to a survival bias (sick patients died early), but also to a better HF management. Despite that, there is still much room for improvement.