The creation of cost-effective diagnostic approaches including a greater involvement of cardiovascular services in the evaluation of unexplained falls should be considered given the significant magnitude of the problem, based on a Utah case study of patients presenting with faint or fall that was featured May 13 at the 2010 annual conference of the Heart Rhythm Society (HRS) in Denver.
Understanding the frequency and economic impact of patients presenting with faint or fall is a prerequisite for the creation of cost-effective diagnostic approaches, according to lead author Gangadhar R. Malasana, MD, from the University of Utah in Salt Lake City, and colleagues.
The researchers evaluated the total number of patients presenting to the University of Utah and the nine affiliated primary care and family practice clinics between Nov. 1, 2008, and Oct. 31, 2009, with faint or fall.
According to the investigators, a total of 1,936 and 6,043 patients presented with faint and fall resulting in a total number of visits equal to 2,701 and 8,163, respectively. The yearly incidence of faint was 9.5 patients (13.2 visits) per 1,000 inhabitants and the yearly incidence of fall was 29.8 patients (40.2 visits) per 1,000 inhabitants. The average ages were 48 and 46, with 59 percent and 53 percent being female respectively. In both patient populations, two-thirds of visits were as outpatients.
“While the cardiovascular service was involved in the evaluation of faint patients in 24.5 percent of the outpatient visits, less than 1 percent of outpatient fall visits resulted in a cardiovascular consultation,” Malasana and his colleagues wrote.
They found that the average payments received per faint and fall patient evaluation and the resultant estimated yearly payments representing the total costs to the healthcare system are:
|Inpatient admission payment||$12,640||$19,194|
|Outpatient visit payment||$499||$366|
|Emergency department visit||$1,105||$711|
|Payment per one million inhabitants/year||$34.83 million||$95.36 million|
|Payment to Utah/year (2.74 million inhabitants)||$95.28 million||$260.9 million|
Malasana and colleagues claimed that this is first study to highlight the magnitude of the faint and fall problem, and they estimated that the state of Utah incurs yearly costs of approximately $355 million.