[Management, cost and mortality of a cohort of patients with advanced heart failure (the EPICAL study)].

The objectives of this study are to describe the management, outcomes and costs of patients with severe chronic heart failure (CHF) and to identify the associated socio-demographic and clinical determinants. In 1994, the EPICAL study enrolled in a French region a representative cohort of 358 patients presenting for the first time with severe CHF (NYHA class III or IV) requiring hospitalization. The mean annual cost per patient was 125 652 FF, 92.6 per cent of which was associated with in-patient care including the index hospitalization. Ten per cent of patients contributed 33 per cent of the total cumulative costs. The rate of readmission was very high (20 per cent per month of follow-up) and appeared as a major cost driver. Three variables were identified in a multivariate logistic regression as the main contributors to cost: the presence of co-morbidity, renal insufficiency and marital status (living alone versus with spouse). These findings confirmed the major clinical and economic interest of any intervention that could lower the rate of readmissions in this group of patients.