A discussion on how the economic burden of management differs for patients with HFpEF and HFrEF.
Jaime Murillo, MD: What is the difference in economic burden between preserved and reduced ejection fraction? I don’t think we have a good analysis about that. You’d probably find some in the literature, but from our standpoint, we still treat heart failure as a single bucket. I can tell you how much we spend in heart failure. We still have an opportunity to address what the difference is, but we know that the [the total cost is] about 50/50, essentially, between [heart failure with preserved and reduced ejection fraction]. You could make the argument that the main cost and the drivers on the reduced ejection fraction side are related to the underlying comorbidities. That’s a major driver of cost in addition to the hospitalization, obviously.
On the preserved ejection fraction side, we have not done this type of analysis, but we certainly need to move in that direction. I would argue that those with heart failure with preserved ejection fraction are equally if not more expensive than reduced heart failure when you talk about cost of utilization. This is because the mortality is slightly lower on the preserved side, because they’re more likely to be readmitted, because they can decompensate more quickly, and because there’s no good alternative to treating the preserved ejection fraction as of today.
For the others, you could make the argument that once the heart is bad, it’s hard to get it back. You could at least find some reversible causes to treat, which may be doing a valve replacement, and it maybe treating their ischemic heart disease. On the preserved side, those patients are going to live longer, theoretically. They may go to the hospital more often, and they may not have the same quality of life as well. I’m not saying that the quality of life for reduced ejection fraction is any better, but in general, what I’m saying is that we may overlook the preserved ejection fraction in terms of cost. The cost associated with treating preserved ejection fractionhas not been well assessed, and it can be as high or higher than reduced ejection fraction.