5.8 Million people in the U.S. suffer from CHF and this accounts for over 1 million hospitalizations a year. Rehospitalization rates approach 30% at 90 days. The costs to treat heart failure are over $37 Billion a year. The majority of the costs of heart failure come from hospitalizations and repeat hospitalizations. Hospitalizations account for 67 to 80% of the total cost. Most of this data can be referenced from an article in the 2013 issue of the Journal of the American College of Cardiology
It is disturbing that heart failure is only DRG (Diagnosis Related Group) diagnosis that is still increasing in incidence in those over age 65 years. This 2007 study published in the American Heart Journal in 2007 shows that mortality nearly doubles after every admission.
This large study with over 14,000 patients out of British Columbia looked at 1 year survival after admission. The conclusions were that after
adjusting for age, sex, and major comorbidities, the number of HF hospitalizations was a strong predictor of all-cause death. Median survival after the first, second, third, and fourth hospitalization was 2.4, 1.4, 1.0, and 0.6 years. Advanced age, renal disease, and history of cardiac arrest attenuated the impact of the number of HF hospitalizations.
A study in the 1995 issue of Annals of Internal Medicine looked at the causes for CHF readmissions. The main ones are included in this figure.
Patients also had a tremendous number of co-morbidities that contributed to their rehospitalizations and increased mortality. So often there problems are dealt with separately.
There are also significant issues with poor monitoring of drug regimens and inadequate dosing and monitoring. Several studies have looked at the suboptimal treatment of these patients. Many practioners are undertreating patients or are unfamiliar with newer medications. The ACC guidelines are often not followed.