Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database.

BACKGROUND: Heterogeneity of disease severity and clinical trajectory has been described among patients hospitalized with heart failure (HF). However, little is known about the variability in and contributors to costs associated with HF hospitalizations. We examined the distribution of costs associated with a HF diagnosis in a large contemporary hospital database.
METHODS: Diagnosis and procedure codes were systematically used to identify primary inpatient HF admissions to hospitals participating in the PREMIER database 2004-2005. Average costs per day and division of costs among hospital departments were evaluated based on patient and hospitalization characteristics.
RESULTS: Total number of hospitalizations was 278,214; 36% had a length of stay (LOS) >5 days. There was a clear association between type of intravenous therapy, LOS, inhospital mortality, and cost. For example, patients initiated on a single intravenous inotrope had a longer mean LOS (9.6 days), greater inhospital mortality rate (14.7%), and higher mean total cost ($18,411) than any other medical therapy administered during hospitalization. The single largest contributor to cost was room and board. Forty-six percent of hospitalizations with diagnosis-related group code 127 (n = 234,204) exceeded average Medicare reimbursement. Variables on admission associated with highest cost hospitalizations were age <75 years, non-black race, male sex, and urban teaching hospital status.
CONCLUSIONS: Length of stay is the determinant of cost for HF hospitalizations. Use of vasoactive therapy is a marker for longer LOS, higher mortality, and greater costs. Improved reimbursement rates or improved therapeutic options that lessen LOS are required if the costs of HF care are to be minimized.