Recurrent hospitalizations in patients with congestive heart failure (CHF) represent a major financial burden for the health care system. We previously found that preemptive treatment based on monitoring lung impedance (LI) can prevent 55% of hospitalizations for acute heart failure (AHF).
Aim: To assess the effect of LI-guided therapy as compared with conventional treatment in patients admitted for AHF on the incidence and cost of recurrent hospitalizations.
Method and Results: 250 patients [(68 ± 11 years-old, male- 80%, LVEF- 28 ± 9%, initial NT-proBNP level- 3594 ± 5114 pg/ml, follow-up duration- 36 ± 22 months (7500 visits), NYHA II/III/IV (107/100/43)] were randomized to the LI-guided group 1 (n = 124) and group 2 (n = 126) who were treated by clinical assessment. Hospitalizations for AHF were recorded annually for both groups during 8-years of follow up. Hospitalizations per year were divided by number of patients followed that year and normalized to 100 patients. We estimated the average cost of AHF hospitalization as 18000$. Incidence of hospitalizations/100 patients during 1-8 year was 64, 31, 61, 57, 51, 15, 44, 77 in group 1 and 120, 68, 105, 111, 65, 73, 137, 150 in group 2 (p < 0.001). Cumulative savings for the health care system by using LI-guided therapy in 100 patients during the first 8 years was 1, 1.7, 2.5, 3.5, 3.7, 4.7, 6.4 and 7.7 $million, respectively. Cost of LI device for one patient was 1000$ for the first year and 500$ for each following year. The net profit of the health care system after 8 years of treatment was 7.7 million$ (saved hospitalizations) - 0.45 million$ (cost of devices with service) = 7.25 million$. Calculated net profit for one patient treated according LI for one year was 9063$.
Conclusion: The strategy of LI-guided therapy not only reduced significantly hospitalizations for AHF but also decreased the cost of therapy by 9063$/year for each patient.