Hospitalization and medical cost of patients with elevated serum N-terminal pro-brain natriuretic peptide levels.

Toshiro Kitagawa,Mariko Mizukawa,Noboru Oda,Susumu Nakayama,Makiko Naka,Takayuki Hidaka,Yasuki Kihara,Yoshiaki Taniyama

doi:10.1371/journal.pone.0190979

Abstract

BackgroundPatients with heart failure (HF) are reportedly at high risk for ‘all-cause’ re-hospitalization. A biomarker for HF, N-terminal pro-brain natriuretic peptide (NT-proBNP), enables to simply detect patients with possible HF (pHF). We examined the hospitalization and medical cost of Japanese patients detected by an elevated serum NT-proBNP, and also evaluated the effects of institutional team approaches for HF on their all-cause hospitalizations.MethodsWe retrospectively extracted all adult patients with serum NT-proBNP ≥400 pg/ml measured between January and March 2012 in Hiroshima University Hospital as pHF-positive patients. We studied their all-cause hospitalization records during the past 3-year period. We also extracted all pHF-negative patients with NT-proBNP <400 pg/ml and studied as well. In the pHF-positive patients followed for 3 years after starting interprofessional team approaches to prevent the onset and exacerbation of HF in the hospital, we compared the hospitalization and medical cost between the 3-year periods before and after the start of the team approaches.ResultsWe enrolled 432 pHF-positive and 485 pHF-negative patients with one or more hospitalization records. Compared to the pHF-negative patients, the pHF-positive patients had longer total hospitalization days (median [interquartile range], 30 [13–58] versus. 18 [8–39], p <0.0001) and higher total medical cost for hospitalizations (2.42 [1.07–5.08] versus. 1.80 [0.79–3.65] million yen, p <0.0001). A subset of 303 pHF-positive patients was followed for 3 years after starting the team approaches, and we found that both total hospitalization days (30 [13–57] to 8 [0–31]) and medical cost for hospitalizations (2.59 [1.37–5.05] to 0.76 [0–2.38] million yen) showed marked reduction in them.ConclusionsPatients with an elevated serum NT-proBNP have longer hospitalizations and higher costs for all-cause hospitalizations than those without. Institutional team approaches for HF may reduce them.

Highlights

Considerable medical resources are consumed on the care of heart failure (HF) due to repeated admissions of the patients
We examined the hospitalization and medical cost of Japanese patients detected by an elevated serum NT-proBNP, and evaluated the effects of institutional team approaches for HF on their all-cause hospitalizations
A subset of 303 possible HF (pHF)-positive patients was followed for 3 years after starting the team approaches, and we found that both total hospitalization days (30 [13–57] to 8 [0–31]) and medical cost for hospitalizations (2.59 [1.37–5.05] to 0.76 [0– 2.38] million yen) showed marked reduction in them

Summary

Introduction

Considerable medical resources are consumed on the care of HF (heart failure) due to repeated admissions of the patients. In a report from the United States, patients hospitalized for HF are at high risk for ‘all-cause’ re-hospitalization [1], which is considered to reflect severe comorbidities accompanied with HF [2]. Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are the most-established biomarkers for HF. They are secreted under conditions of pressure and volume overload in the ventricular myocardium. Patients with heart failure (HF) are reportedly at high risk for ‘all-cause’ re-hospitalization. We examined the hospitalization and medical cost of Japanese patients detected by an elevated serum NT-proBNP, and evaluated the effects of institutional team approaches for HF on their all-cause hospitalizations

Methods

Results

Conclusion