Abstract 12158: Population Thresholds for Systematically Applying Nurse-Led Chronic Heart Failure Management Programs to Reduce Recurrent Hospitalization and Prolong Survival

Abstract

Background: In many countries, a jurisdictional (regional or health fund membership) approach to applying nurse-led, multidisciplinary management programs for high risk individuals hospitalized with chronic heart failure (CHF) has led to their inconsistent application. A health service perspective was therefore used to determine the overall value of funding services for a whole population. Methods: Data from a contemporary study of the burden of CHF in Australia (population ~ 24 million of whom ~25% live in regional settings) to identify the number of de novo admissions for CHF per annum (n=19,397) were used. From these we estimated the proportion of cases readmitted (63% - all cause), days of related hospitalization (44,500 days from 5,300 admissions) and case-fatality (27%) within 12 months. Health economic data from a recent multicentre trial of CHF management were then applied to estimate the cost impact ($US) of applying gold-standard management to de novo CHF cases. Results: Total health care expenditure (excluding index admission and incremental CHF management) for managing de novo cases of CHF is estimated at ~$300 million/annum. Of this total, $240 million (68%) is attributable to hospital care plus device-based therapies. Applying nurse-led multidisciplinary CHF management to all cases (with up-titration of therapy and increased face-to-face and remote contacts as required) would cost ~ $35 million/annum. In order to achieve a cost-neutral state, this service would need to achieve a minimum reduction of 6,500 days (15% reduction) in recurrent hospital stay (all cause). At proven, evidence-based thresholds of impact, a 20% - 30% reduction in recurrent hospital stay would provide annual savings of $12 - 35 million/annum. A one third reduction in mortality at 12 months would also result in 2,100 lives saved at a minimum cost >$17,000 per annum (neutral impact on recurrent hospital stay). Conclusions: These data provide a compelling case for adopting a whole population/health care system approach to systematically applying CHF management programs to reduce recurrent hospital stay and mortality in de novo cases of CHF.