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9. Economic Issues in Heart Failure in the United States

Author

Heidenreich, Paul A, Fonarow, Gregg C, Opsha, Yekaterina, Sandhu, Alexander T, Sweitzer, Nancy K, Warraich, Haider J, Chair, HFSA Scientific Statement Committee Members, Butler, Javed, Hsich, Eileen, Pressler, Susan Bennett, Shah, Kevin, Taylor, Kenneth, Sabe, Marwa, and Ng, Tien

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Clinical Research, Clinical Trials and Supportive Activities, Heart Disease - Coronary Heart Disease, Comparative Effectiveness Research, Heart Disease, Health Services, Cost Effectiveness Research, Cardiovascular, 5.1 Pharmaceuticals, 8.2 Health and welfare economics, Health and social care services research, Development of treatments and therapeutic interventions, Good Health and Well Being, Adrenergic beta-Antagonists, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Cost-Benefit Analysis, Heart Failure, Hospitalization, Humans, Mineralocorticoid Receptor Antagonists, United States, HFSA Scientific Statement Committee Members Chair, Cardiorespiratory Medicine and Haematology, Nursing, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

The cost of heart failure care is high owing to the cost of hospitalization and chronic treatments. Heart failure treatments vary in their benefit and cost. The cost effectiveness of therapies can be determined by comparing the cost of treatment required to obtain a certain benefit, often defined as an increase in 1 year of life. This review was sponsored by the Heart Failure Society of America and describes the growing economic burden of heart failure for patients and the health care system in the United States. It also provides a summary of the cost effectiveness of drugs, devices, diagnostic tests, hospital care, and transitions of care for patients with heart failure. Many medications that are no longer under patent are inexpensive and highly cost-effective. These include angiotensin-converting enzyme inhibitors, beta-blockers and mineralocorticoid receptor antagonists. In contrast, more recently developed medications and devices, vary in cost effectiveness, and often have high out-of-pocket costs for patients.

Published
2022

10. HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics An Updated 2024 Report from the Heart Failure Society of America

Author

Bozkurt, Biykem, Ahmad, Tariq, Alexander, Kevin, Baker, William L., Bosak, Kelly, Breathett, Khadijah, Carter, Spencer, Drazner, Mark H., Dunlay, Shannon M., Fonarow, Gregg C., Greene, Stephen J., Heidenreich, Paul, Ho, Jennifer E., Hsich, Eileen, Ibrahim, Nasrien E., Jones, Lenette M., Khan, Sadiya S., Khazanie, Prateeti, Koelling, Todd, Lee, Christopher S., Morris, Alanna A., Page, Robert L., II, Pandey, Ambarish, Piano, Mariann R., Sandhu, Alexander T., Stehlik, Josef, Stevenson, Lynne W., Teerlink, John, Vest, Amanda R., Yancy, Clyde, and Ziaeian, Boback

Published
2024
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12. Predicting the EQ-5D utilities from the Kansas City Cardiomyopathy Questionnaire in patients with heart failure

Author

Thomas, Merrill, Jones, Philip G, Cohen, David J, Suzanne, Arnold V, Magnuson, Elizabeth A, Wang, Kaijun, Thourani, Vinod H, Fonarow, Gregg C, Sandhu, Alexander T, and Spertus, John A

Subjects
Cardiovascular, Clinical Research, Heart Disease, Good Health and Well Being, Cardiomyopathies, Heart Failure, Humans, Kansas, Quality of Life, Stroke Volume, Surveys and Questionnaires, Health economics, Health status, Utilities
Abstract

IntroductionEvaluation of health status benefits, cost-effectiveness, and value of new heart failure therapies is critical for supporting their use. The Kansas City Cardiomyopathy Questionnaire (KCCQ) measures patients' heart failure-specific health status but does not provide utilities needed for cost-effectiveness analyses. We mapped the KCCQ scores to EQ-5D scores so that estimates of societal-based utilities can be generated to support economic analyses.MethodsUsing data from two US cohort studies, we developed models for predicting EQ-5D utilities (3L and 5L versions) from the KCCQ (23- and 12-item versions). In addition to predicting scores directly, we considered predicting the five EQ-5D health state items and deriving utilities from the predicted responses, allowing different countries' health state valuations to be used. Model validation was performed internally via bootstrap and externally using data from two clinical trials. Model performance was assessed using R2, mean prediction error, mean absolute prediction error, and calibration of observed vs. predicted values.ResultsThe EQ-5D-3L models were developed from 1000 health status assessments in 547 patients with heart failure and reduced ejection fraction (HFrEF), while the EQ-5D-5L model was developed from 3925 patients with HFrEF. For both versions, models predicting individual EQ-5D items performed as well as those predicting utilities directly. The selected models for the 3L had internally validated R2 of 48.4-50.5% and 33.7-45.6% on external validation. The 5L version had validated R2 of 57.7%.ConclusionMappings from the KCCQ to the EQ-5D can yield the estimates of societal-based utilities to support cost-effectiveness analyses when EQ-5D data are not available.

Published
2021

13. Automated coronary calcium scoring using deep learning with multicenter external validation.

Author

Eng, David, Chute, Christopher, Khandwala, Nishith, Rajpurkar, Pranav, Long, Jin, Shleifer, Sam, Khalaf, Mohamed H, Sandhu, Alexander T, Rodriguez, Fatima, Maron, David J, Seyyedi, Saeed, Marin, Daniele, Golub, Ilana, Budoff, Matthew, Kitamura, Felipe, Takahashi, Marcelo Straus, Filice, Ross W, Shah, Rajesh, Mongan, John, Kallianos, Kimberly, Langlotz, Curtis P, Lungren, Matthew P, Ng, Andrew Y, and Patel, Bhavik N

Subjects
Heart Disease - Coronary Heart Disease, Prevention, Atherosclerosis, Heart Disease, Clinical Research, Cardiovascular, Health Services, Biomedical Imaging, Bioengineering, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Good Health and Well Being
Abstract

Coronary artery disease (CAD), the most common manifestation of cardiovascular disease, remains the most common cause of mortality in the United States. Risk assessment is key for primary prevention of coronary events and coronary artery calcium (CAC) scoring using computed tomography (CT) is one such non-invasive tool. Despite the proven clinical value of CAC, the current clinical practice implementation for CAC has limitations such as the lack of insurance coverage for the test, need for capital-intensive CT machines, specialized imaging protocols, and accredited 3D imaging labs for analysis (including personnel and software). Perhaps the greatest gap is the millions of patients who undergo routine chest CT exams and demonstrate coronary artery calcification, but their presence is not often reported or quantitation is not feasible. We present two deep learning models that automate CAC scoring demonstrating advantages in automated scoring for both dedicated gated coronary CT exams and routine non-gated chest CTs performed for other reasons to allow opportunistic screening. First, we trained a gated coronary CT model for CAC scoring that showed near perfect agreement (mean difference in scores = -2.86; Cohen's Kappa = 0.89, P

Published
2021

15. Risk of Severe COVID-19 in Prevalent Users of Alpha-1 Adrenergic Receptor Antagonists: A National Case-Control Study of Medicare Beneficiaries

Author

Graham, David J., Izurieta, Hector S., Zhang, Di, Avagyan, Armen, Lyu, Hai, Wiederhorn, Roger, Lu, Yun, Mosholder, Andrew D., Smith, Elizabeth R., Zhao, Yueqin, Shangguan, Shanlai, Tsai, Huei-Ting, Pennap, Dinci, Sandhu, Alexander T., Wernecke, Michael, MaCurdy, Thomas E., Kelman, Jeffrey A., and Forshee, Richard A.

Published
2023
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28. Applying natural language processing to identify emergency department and observation encounters for worsening heart failure

Author

Hamilton, Steven A., primary, Ambrosy, Andrew P., additional, Parikh, Rishi V., additional, Tan, Thida C., additional, Fitzpatrick, Jesse K., additional, Avula, Harshith R., additional, Sandhu, Alexander T., additional, Ku, Ivy A., additional, Go, Alan S., additional, Sax, Dana, additional, and Bhatt, Ankeet S., additional

Published
2024
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31. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Author

Heidenreich, Paul A., Bozkurt, Biykem, Aguilar, David, Allen, Larry A., Byun, Joni J., Colvin, Monica M., Deswal, Anita, Drazner, Mark H., Dunlay, Shannon M., Evers, Linda R., Fang, James C., Fedson, Savitri E., Fonarow, Gregg C., Hayek, Salim S., Hernandez, Adrian F., Khazanie, Prateeti, Kittleson, Michelle M., Lee, Christopher S., Link, Mark S., Milano, Carmelo A., Nnacheta, Lorraine C., Sandhu, Alexander T., Stevenson, Lynne Warner, Vardeny, Orly, Vest, Amanda R., and Yancy, Clyde W.

Published
2022
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32. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Author

Heidenreich, Paul A., Bozkurt, Biykem, Aguilar, David, Allen, Larry A., Byun, Joni J., Colvin, Monica M., Deswal, Anita, Drazner, Mark H., Dunlay, Shannon M., Evers, Linda R., Fang, James C., Fedson, Savitri E., Fonarow, Gregg C., Hayek, Salim S., Hernandez, Adrian F., Khazanie, Prateeti, Kittleson, Michelle M., Lee, Christopher S., Link, Mark S., Milano, Carmelo A., Nnacheta, Lorraine C., Sandhu, Alexander T., Stevenson, Lynne Warner, Vardeny, Orly, Vest, Amanda R., and Yancy, Clyde W.

Published
2022
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33. 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure: Executive Summary

Author

Heidenreich, PAUL A., BOZKURT, BIYKEM, AGUILAR, DAVID, ALLEN, LARRY A., BYUN, JONI-J., COLVIN, MONICA M., DESWAL, ANITA, DRAZNER, MARK H., DUNLAY, SHANNON M., EVERS, LINDA R., FANG, JAMES C., FEDSON, SAVITRI E., FONAROW, GREGG C., HAYEK, SALIM S., HERNANDEZ, ADRIAN F., KHAZANIE, PRATEETI, KITTLESON, MICHELLE M., LEE, CHRISTOPHER S., LINK, MARK S., MILANO, CARMELO A., NNACHETA, LORRAINE C., SANDHU, ALEXANDER T., STEVENSON, LYNNE WARNER, VARDENY, ORLY, VEST, AMANDA R., and YANCY, CLYDE W.

Published
2022
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38. Risk of Covid-19-Related Hospitalization and More Severe Outcomes in Medicare Beneficiaries Treated with Renin-Angiotensin-Aldosterone System Inhibitors for Hypertension

Author

Graham, David J., Izurieta, Hector S., Muthuri, Stella G., Zhang, Di, Sandhu, Alexander T., Lu, Yun, Zhao, Yueqin, Feng, Yuhui, Eworuke, Efe, Lyu, Hai, Gandotra, Charu, Smith, Elizabeth R., Avagyan, Armen, Wernecke, Michael, Kelman, Jeffrey A., Forshee, Richard A., and MaCurdy, Thomas E.

Published
2021
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39. Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography

Author

Nurmohamed, Nick S, primary, van Rosendael, Alexander R, additional, Danad, Ibrahim, additional, Ngo-Metzger, Quyen, additional, Taub, Pam R, additional, Ray, Kausik K, additional, Figtree, Gemma, additional, Bonaca, Marc P, additional, Hsia, Judith, additional, Rodriguez, Fatima, additional, Sandhu, Alexander T, additional, Nieman, Koen, additional, Earls, James P, additional, Hoffmann, Udo, additional, Bax, Jeroen J, additional, Min, James K, additional, Maron, David J, additional, and Bhatt, Deepak L, additional

Published
2024
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42. Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial.

Author

Sandhu, Alexander T., Calma, Jamie, Skye, Megan, Kalwani, Neil, Zheng, Jimmy, Schirmer, Jessica, Din, Natasha, Johnson, Cati Brown, Gupta, Anshal, Lan, Roy, Yu, Brian, Spertus, John A., and Heidenreich, Paul A.

Subjects
*HEART failure, *EMERGENCY room visits, *HEART failure patients, *CLINICAL trials, *MEDICAL personnel
Abstract

BACKGROUND: The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year. METHODS: The PRO-HF trial (Patient-Reported Outcome Measurement in Heart Failure Clinic) was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit, and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 overall summary score (OSS) between 12 and 15 months after randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates. RESULTS: Across 17 clinicians, 1248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 years (interquartile range [IQR], 51.8--72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR, 58.3--94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care; P=0.16) median OSS were 87.5 (IQR, 68.8--96.9) in the PRO arm and 87.6 (IQR, 69.7--96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 ([95% CI, -1.7 to 2.0]; P=0.85). The results were consistent across prespecified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with a baseline KCCQ-12 OSS of 60 to 80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, emergency department visits, medication therapy, clinic follow-up, or testing rates between arms. CONCLUSIONS: Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04164004. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Challenge of Optimizing Medical Therapy in Heart Failure: Unlocking the Potential of Digital Health and Patient Engagement

Author

Azizi, Zahra, primary, Golbus, Jessica R., additional, Spaulding, Erin M., additional, Hwang, Phillip H., additional, Ciminelli, Ana L. A., additional, Lacar, Kathleen, additional, Hernandez, Mario Funes, additional, Gilotra, Nisha A., additional, Din, Natasha, additional, Brant, Luisa C. C., additional, Au, Rhoda, additional, Beaton, Andrea, additional, Nallamothu, Brahmajee K., additional, Longenecker, Chris T., additional, Martin, Seth S., additional, Dorsch, Michael P., additional, and Sandhu, Alexander T., additional

Published
2024
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44. Design and Implementation of an Electronic Health Record‐Integrated Hypertension Management Application

Author

Funes Hernandez, Mario, primary, Babakhanian, Meghedi, additional, Chen, Tania P., additional, Sarraju, Ashish, additional, Seninger, Clark, additional, Ravi, Vishnu, additional, Azizi, Zahra, additional, Tooley, James, additional, Chang, Tara I., additional, Lu, Ying, additional, Downing, N. Lance, additional, Rodriguez, Fatima, additional, Li, Ron C., additional, Sandhu, Alexander T., additional, Turakhia, Mintu, additional, Bhalla, Vivek, additional, and Wang, Paul J., additional

Published
2024
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45. Patient Representativeness With Virtual Enrollment in the PRO‐HF Trial

Author

Gupta, Anshal, primary, Skye, Megan, additional, Calma, Jamie, additional, Din, Natasha, additional, Azizi, Zahra, additional, Hernandez, Mario Funes, additional, Zheng, Jimmy, additional, Kalwani, Neil M., additional, Malunjkar, Sanjay, additional, Schirmer, Jessica, additional, Wang, Paul, additional, Rodriguez, Fatima, additional, Heidenreich, Paul, additional, and Sandhu, Alexander T., additional

Published
2024
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50. Developing Clinical Risk Prediction Models for Worsening Heart Failure Events and Death by Left Ventricular Ejection Fraction

Author

Parikh, Rishi V., primary, Go, Alan S., additional, Bhatt, Ankeet S., additional, Tan, Thida C., additional, Allen, Amanda R., additional, Feng, Kent Y., additional, Hamilton, Steven A., additional, Tai, Andrew S., additional, Fitzpatrick, Jesse K., additional, Lee, Keane K., additional, Adatya, Sirtaz, additional, Avula, Harshith R., additional, Sax, Dana R., additional, Shen, Xian, additional, Cristino, Joaquim, additional, Sandhu, Alexander T., additional, Heidenreich, Paul A., additional, and Ambrosy, Andrew P., additional

Published
2023
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