- Better chronic disease management for heart failure patients with one or more comorbidities can lower the risk of those patients ending up back in the hospital after an acute event, finds a study from the American Journal of Managed Care. While nearly all of the Medicaid heart failure patients in the cohort experienced at least one hospitalization during the study period, heart failure was only the primary admitting diagnosis in about one-third of cases. By increasing the use of certain medications for cardiovascular disease management, the healthcare industry has the opportunity to reduce readmissions, improve quality of life, and significantly cut down on costs.
“Healthcare reform and ongoing healthcare discussions have stimulated an interest in needs and risk assessment for target high-risk populations,” the authors from the University of Maryland, Brigham and Women’s Hospital, and Harvard Medical School write. “In particular, the growing ranks of Medicaid plans and the rise of national health and other entitlement programs call for more deliberate, proactive, and cost-effective disease and risk management of plan enrollees.”
In an effort to uncover strategies for lowering costs in Maryland, the researchers examined data on more than 7000 of the state’s Medicaid heart failure patients, most of whom were over the age of 45. Ninety-eight percent were diagnosed with at least one additional chronic disease, including hypertension, COPD, renal dysfunction, stroke, and hyperlipidemia. Patients with COPD or store had a 30 percent greater risk of hospitalization, while diabetes and ischemic heart disease raised the risk by 25 percent. Renal failure produced the highest risk at 40 percent.
Heart failure patients with renal failure also experienced the shortest time to rehospitalization at an average of 73 days, while those with hyperlipidemia were least likely to return to the hospital, doing so at an average of 238 days. Heart failure patients with no comorbidities stayed out of the inpatient setting for 290 days.
Only 63 percent of hospitalized patients received any type of cardiovascular follow-up treatment, with 29 percent receiving ACEi/ARBs and 26% taking beta-blockers. These drugs and other cardiovascular treatments significantly lowered the risk of a quick rehospitalization, which in turn produced savings for the Maryland Medicaid program.
For every twelve patients started on an appropriate cardiovascular disease management program, at least one hospitalization can be prevented, the study found. Increasing the prescription rate by 20% equates to a savings of approximately $85 per heart failure patient. By extrapolating that number to the statewide heart failure population, Medicaid could save just over one million per year.
“This study is the first to address the epidemiology of comorbidities in a high-risk Medicaid population, reflecting a demographic largely under-represented in large-scale studies or clinical trials,” the authors conclude. “We show the unmet needs of this population and the clinical and hospitalization issues associated with prevalent disease and therapies. The burden of comorbidity was much higher than that observed in national statistics on heart failure patients, and the prescribing prevalence was lower than expected given the high-risk profile of the population.”
“These findings may point to a high-priority area for Medicaid plans. Most notably, in the context of the study’s population demographic and clinical profile, we found that even small increments in disease-modifying therapies would result in significant reduction in costs to state plans.”