Sex-specific outcomes and resource utilisation after HF hospitalisation

Five years after heart failure (HF) hospitalisation, clinical outcomes and overall costs were similar between men and women in the PACT-HF study. However, the distribution of costs between the sexes differed. Costs were greater for specialist and day surgical care for men, whereas the costs for home care and long-term residence care were higher for women.

The cluster-randomised PACT-HF trial (NCT02112227) evaluated a transitional care service following HF hospitalisation [1,2]. Dr Tauben Averbuch (University of Calgary, Canada) and colleagues explored sex differences in clinical outcomes and annualised resource utilisation after HF hospitalisation in this population [2]. The study included 2,253 women and 2,188 men ≥18 years of age. Some notable differences at baseline were that women had a higher mean age (78.5 vs 73.9 years), more often resided in long-term care (18.9% vs 10.3%), had a higher left ventricular ejection fraction (49.0 vs 42.2), and had a higher prevalence of dementia (10.5% vs 7.1%); P<0.01 for all comparisons.

Among participants hospitalised for HF, 5-year clinical event rates were high. The primary outcome was all-cause mortality. Over half of all participants had died; 5-year all-cause mortality exceeded that of many cancers. No significant sex differences were observed in all-cause death (65.5% of women vs 63.6% of men), death in hospital (55.7% vs 56.7%, respectively), or re-admission (84.4% vs 85.4%, respectively).

Costs following HF hospitalisation were high; nearly half of these costs were driven by re-admission. Although mean annual costs per participant 1 and 5 years after hospitalisation did not differ significantly between men and women, the distribution of healthcare costs did vary. Costs of HF clinics and specialist billings were higher for men, whereas costs for home care and long-term care were higher for women. Healthcare utilisation in the 5 years after hospitalisation showed no differences between the sexes in terms of cardiac invasive care. However, women received fewer ambulatory visits (5.1 vs 6.7), more homecare visits (69.0 vs 54.2), and more cumulative days of long-term care (48.3 vs 21.9).

1. 
   
   1. Van Spall HGC, et al. JAMA. 2019;321:753–61.
   2. Averbuch T, et al. Sex-specific clinical outcomes and healthcare resource utilization for the 5 years following hospitalization for heart failure. Late breaking clinical trials: registries, Heart Failure 2024, 11–14 May, Lisbon, Portugal.

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Posted on 16 July 202416 July 2024