HFSA: Comorbidities lead to higher HF expenditures

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BOSTON—The severity of heart failure (HF) may play a role in the overall commonness of comorbidities, Robert Lee Page II, PharmD, associate professor in the department of clinical pharmacy at the University of Colorado Anschutz medical campus in Denver, said during a Sept. 19 presentation at the 15th annual Heart Failure Society of America (HFSA) scientific meeting. While some comorbidities (hypertension, COPD and coronary artery disease) have been well-recognized, depression and obesity are beginning to crop up as potential problems.

During his presentation, Lee Page looked at the “complexities and mysteries of comorbidities.” Comorbidities are intertwined with chronic conditions, which are conditions that last for more than one year, cause disability and increase health resources, said Lee Page, who estimated the number of people in the U.S. living with a chronic condition to be 141 million.

In 2001, 24 percent of all Americans had at least two or more chronic conditions. For patients with one or more chronic conditions, the average per capita spending is more than five times greater than spending on people without chronic conditions.

“Spending is [more than] two and a half times greater for someone with one chronic condition,” Lee Page noted. “Two-thirds of Medicare expenditures is spent on patients with five or more chronic conditions.”

Lee Page noted that between 1988 and 1998, heart failure went from being fairly simple to very complex.

While 80 to 81 percent of HF patients have hypertension, COPD or coronary artery disease, over the last 20 years, obesity, depression and thyroid disease have become additional chronic conditions physicians must worry about.

“As a patient’s heart failure severity moves from mild to severe, the risk of cormorbidities increases,” Lee Page said. Additionally, Lee Page noted that the total number of office visits for patients with mild to severe HF ranged from 10 to 11, and the majority of these visits are for something other than HF.

“We know that patients with heart failure have grown substantially more complex over the last two decades and we have also seen emergence of diabetes, obesity, kidney disease and thyroid disease,” Lee Page offered.

“Comorbidities in this patient population increase healthcare resource expenditures,” said Lee Page; and the severity of HF plays a role in the increasing numbers of comorbidities seen today.