The economic impact of MR on heart failure patients

Newly diagnosed heart failure (HF) patients with concomitant mitral regurgitation (MR) can expect more admissions, longer hospital stays and pricier medical bills than HF patients without MR, according to an analysis published in the American Journal of Cardiology.

Peter A. McCullough, MD, MPH, of Baylor University Medical Center, and his colleagues found that on average, people who present with both HF and MR rack up $2,400 more in healthcare expenses and experience 23% more HF hospitalizations than non-MR patients each year. They studied data from the Truven Health MarketScan Commercial Claims and Medicare Supplemental databases, including patients with at least one inpatient claim or two outpatient claims for HF in their study.

To be eligible for the analysis, patients in McCullough et al.’s study had to have filed those claims within six months of the study’s baseline. A six-month post-period—the landmark period—was used to capture MR diagnosis and severity, and following that period patients had to have 12 months of continuous medical and prescription drug plan enrollment with at least two records of HF medication refills.

McCullough and colleagues said HF is already a major clinical and economic burden in the U.S. population, and diagnoses are only expected to increase as the population ages and grows. HF patients are often hospitalized, and hospitalizations are the biggest contributor to treatment costs for CVD. More than half of the estimated $100.9 billion in direct costs in 2013 could be attributed to hospital care, and that same year the cost of cardiac medications in the U.S. settled somewhere around $9.6 billion.

The authors split their medically managed HF patients into three groups: no MR, insignificant MR (iMR) and significant MR (sMR). All analyses controlled for baseline demographics, comorbid conditions and therapeutic intensity. 

The study found that medically managed incident HF patients with sMR experienced significantly more days in the hospital than their no MR counterparts (1.91 vs. 1.72 days, respectively), and higher annual expenditures ($23,988 vs. $21,530). McCullough et al. didn’t note any differences between no MR and iMR patients.

Admissions data, too, reflected a gap—sMR patients had an estimated 50% greater HF admissions rate than no MR patients. In addition, HF admits for iMR were 23% higher than admits for no MR.

“In this retrospective, real-world analysis of medically managed patients with an incident HF diagnosis, patients with concomitant sMR experienced significantly more HF admissions, hospital days and annual expenditures,” McCullough and colleagues wrote. “The increased utilization and expenditure results represent newly diagnosed patients in their first year of medical management. The increase in expenditures comes from HF patients with sMR at the time of the HF diagnosis.”

The team acknowledged their study had “all the limitations of retrospective analyses using claims data” and therefore couldn’t account for variables not included in administrative databases, including echocardiography results.