PMID- 14636907
OWN - NLM
STAT- MEDLINE
DCOM- 20040121
LR  - 20190623
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 92
IP  - 11
DP  - 2003 Dec 1
TI  - Impact of chronic kidney disease and anemia on hospitalization expense in 
      patients with left ventricular dysfunction.
PG  - 1300-5
AB  - To estimate the independent effects of kidney disease, anemia, and the treatment 
      effects of angiotensin-converting enzyme (ACE) inhibitors on hospitalization cost 
      in patients with heart failure, we used data from the prevention and treatment 
      trials of the Studies of Left Ventricular Dysfunction trial and retrospectively 
      estimated the relative effects of decreased kidney function, as measured by 
      estimated glomerular filtration rate (GFR) at enrollment, and anemia, as measured 
      by hematocrit levels at enrollment, on hospital utilization and expense. 
      Independent of the effects of age, gender, New York Heart Association (NYHA) 
      class, ejection fraction, and the presence of diabetes mellitus, GFR was 
      significantly related to hospitalization expense (percent change in 
      hospitalization expense -16.8%, 95% confidence interval [CI] -11.9% to -21.5%) 
      for GFR >/=90 ml/min/1.73 m(2) compared with GFR <60 ml/min/1.73 m(2)). 
      Similarly, hematocrit levels were significantly related to hospitalization 
      expense (percent change in hospitalization expense -19.9%, 95% CI -10.2% to 
      -28.6%) for hematocrit >/=36% compared with hematocrit <33%). The beneficial 
      effect of the ACE inhibitor enalapril was significantly related to 
      hospitalization expense independent of the effects of GFR and hematocrit (percent 
      change in hospitalization expense -6.8%, 95% CI -3.6% to -9.9% for treatment vs 
      the placebo group), and the beneficial effect was preserved when independently 
      estimated for subgroups with decreased kidney function. Adjusted mean expense per 
      patient per month (PPPM) in the enalapril group was $708 versus $792 in the 
      placebo group. Comparing survivors, enalapril generated annual cost savings 
      greater than the average wholesale price of the drug at Studies of Left 
      Ventricular Dysfunction mean dosage levels. Adjusted expected hospitalization 
      expense varied from $636 PPPM for patients in the lowest hematocrit-GFR risk 
      class (hematocrit >/=36%, GFR >/=90 ml/min/1.73 m(2)) to $1,127 PPPM for those in 
      the highest risk class (hematocrit <33%, GFR <60 ml/min/1.73 m(2)). For patients 
      who survived with reduced kidney function and anemia, ACE inhibitor therapy with 
      enalapril reduced hospitalization expense more than the additional expense of the 
      drug therapy. Thus, kidney disease and anemia are independent risk factors for 
      hospitalization cost in patients with heart failure, and the beneficial effect of 
      ACE inhibitors on hospitalization expense appears to be preserved within kidney 
      disease and anemia subgroups.
FAU - Gregory, Douglas D
AU  - Gregory DD
AD  - Division of Clinical Decision Making, Tufts University School of Medicine, 
      Boston, Massachusetts 02111, USA. dgregory@tufts-nemc.org
FAU - Sarnak, Mark J
AU  - Sarnak MJ
FAU - Konstam, Marvin A
AU  - Konstam MA
FAU - Pereira, Brian
AU  - Pereira B
FAU - Salem, Deeb
AU  - Salem D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 69PN84IO1A (Enalapril)
SB  - IM
MH  - Aged
MH  - Anemia/complications/*economics
MH  - Angiotensin-Converting Enzyme Inhibitors/*economics/therapeutic use
MH  - Chi-Square Distribution
MH  - Enalapril/*economics/therapeutic use
MH  - Female
MH  - Glomerular Filtration Rate
MH  - *Hospital Costs
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Kidney Failure, Chronic/complications/*economics
MH  - Male
MH  - Middle Aged
MH  - Randomized Controlled Trials as Topic
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Ventricular Dysfunction, Left/complications/drug therapy/*economics
EDAT- 2003/11/26 05:00
MHDA- 2004/01/22 05:00
CRDT- 2003/11/26 05:00
PHST- 2003/11/26 05:00 [pubmed]
PHST- 2004/01/22 05:00 [medline]
PHST- 2003/11/26 05:00 [entrez]
AID - S0002914903011834 [pii]
AID - 10.1016/j.amjcard.2003.08.011 [doi]
PST - ppublish
SO  - Am J Cardiol. 2003 Dec 1;92(11):1300-5. doi: 10.1016/j.amjcard.2003.08.011.