Adults with severe heart failure have more doctor visits, medications than others on Medicare

Adults with severe heart failure see almost three times as many Medicare providers each year compared to a typical beneficiary, according to research presented at the American Heart Association's Scientific Sessions 2008.

An analysis conducted by researchers at the University of Colorado and Scios, Inc. showed that:

• Adults with severe heart failure see an average of 23 different providers compared to the typical Medicare beneficiary who sees about 7.9 different providers annually.
• Adults with mild heart failure saw an average of 15.9 providers annually, while those with moderate heart failure saw an average of 18.6 providers.
• Those with all stages of heart failure had an average of 61 prescriptions written in a year; the typical beneficiary had 29.

Adults with heart failure see physicians from different specialties, according to the analysis. About 26 percent of office visits for heart failure were to internal medicine specialists and about 20 percent were to family practice physicians.

Visits to cardiologists for those with mild, moderate and severe heart failure increased as heart failure worsened and were 16 percent, 18 percent and 20 percent, respectively.

"These findings highlight the complexity of treating heart failure patients who often have serious co-morbidities," said Robert Page, Pharm.D., lead author of the study and associate professor of clinical pharmacy and physical medicine and clinical specialist in the Division of Cardiology at the University of Colorado School of Pharmacy and Medicine in Aurora. "These findings stress the importance of developing comprehensive and coordinated care."

With 61 prescriptions being filled each year, the potential for medication errors, adverse drug events and drug-to-drug interactions increases, he said.

Researchers examined the co-morbidities of people with heart failure: 46 percent with severe heart failure had diabetes; 46 percent had chronic obstructive pulmonary disease (COPD), or other respiratory disease; about 32 percent had renal disease.

The total Medicare population is about 34 million, and an estimated 13 percent of them have mild heart failure. The analysis was based on a standard 5 percent sample size of 173,000 beneficiaries. The average age for all beneficiaries was 70.7 years. Heart failure beneficiaries were older; their average age was between 76 and 77 years.

In 2005, Medicare beneficiaries with heart failure accounted for 37 percent of all Medicare spending and nearly 50 percent of all hospital inpatient costs, according to the analysis.

The typical inpatient costs for a severe heart failure patient is about $24,000 annually compared to about $3,000 for a typical Medicare beneficiary.

The designation of mild, moderate and severe heart failure is from the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model and Chronic Care Improvement Program definitions.

"From a public health point of view, we need to have better coordinated care for our patients with cardiovascular disease, not just among physicians, but also among other healthcare professionals," Page said.