Costs rise despite drop in ED length of stay for heart failure

While heart failure length of stay is dropping, the cost of an emergency room visit is growing, a study published in the June issue of the Journal of the American College of Cardiology: Heart Failure found. Heart failure is the top reason for Medicare hospital readmissions and 1 million hospital stays occur each year.

Five million Americans are affected by heart failure and over 80 percent of emergency room patients with acute heart failure are admitted. “Of the $39.2 billion spent on heart failure care in the United States in 2010, hospital stay was the single largest proportion of this expenditure,” wrote Alan B. Storrow, MD, of the Department of Emergency Medicine at Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues. “Among Medicare beneficiaries, hospital stay accounts for more than 50% of all heart failure costs in the last 6 months of life.”

While Storrow et al noted that between 2006 and 2010 the average length of stay dropped, cost increased. In academic hospitals, the median cost of a hospital stay for a heart failure patient went from $17,810 to $22,544, while the median length of stay went from 3.6 to 3.5 days over the same period.

Comparatively, stays at non-academic hospitals had median costs of $16,467 in 2006 to $20,054 in 2010 and a 2006 median length of stay of 3.4 days that dropped in 2010 to 3.2 days.

Length of stay for uninsured patients was shorter overall, 2.9 days in 2006 vs. 2.8 days in 2010. However once admitted, patients experienced a higher frequency of diagnostic and therapeutic procedures. These individuals were generally younger as well, with a median age of around 52 years.

Regions showed high variation in admissions and outcomes. Northeastern patients tended to be older and the proportion of hospital stays was higher than in other regions (89.7 percent vs 83.2 percent in the South, 82.6 percent in the Midwest and 79.2 percent in the West).

Peter S. Pang, MD, MS, of Northwestern University Feinberg School of Medicine in Chicago, and Jeremiah D. Schuur, MD, MHS, of Brigham and Woman’s Hospital in Boston, wrote in an editorial that, “The primary challenge for ED [emergency department] care of  AHF [acute heart failure] lies in identifying those patients who can be rapidly and safely discharged or observed for a brief period, rather than admitting them. Previous analyses suggest nearly 50% of AHF patients could be discharged home or managed in an observation unit (OU).”

Storrow et al recommended considering interventions to reduce cost and hospital visits as a future direction for this field.