PMID- 31984661 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20210621 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 7 IP - 3 DP - 2020 Jun TI - Economic impact of heart failure with preserved ejection fraction: insights from the ALDO-DHF trial. PG - 786-793 LID - 10.1002/ehf2.12606 [doi] AB - AIMS: Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care-related costs of ambulatory HFpEF patients and the effect of spironolactone. METHODS AND RESULTS: The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double-blind, placebo-controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow-up. We used a single-patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities. The average annual costs per patient in this cohort came up to euro1, 118 (+/-2,475), and the median costs were euro332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO(2) max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs. CONCLUSIONS: In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system. CI - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. FAU - Hashemi, Djawid AU - Hashemi D AUID- ORCID: 0000-0003-3933-7092 AD - Department of Internal Medicine and Cardiology, Charite-Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. FAU - Dettmann, Ludwig AU - Dettmann L AD - Department of Cardiology and Pneumology, University of Gottingen, Gottingen, Germany. FAU - Trippel, Tobias D AU - Trippel TD AD - Department of Internal Medicine and Cardiology, Charite-Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. FAU - Holzendorf, Volker AU - Holzendorf V AD - Clinical Trial Centre, University of Leipzig, Leipzig, Germany. FAU - Petutschnigg, Johannes AU - Petutschnigg J AD - Department of Internal Medicine and Cardiology, Charite-Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. FAU - Wachter, Rolf AU - Wachter R AD - DZHK (German Centre for Cardiovascular Research), partner site Gottingen, Gottingen, Germany. AD - Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany. FAU - Hasenfuss, Gerd AU - Hasenfuss G AD - Department of Cardiology and Pneumology, University of Gottingen, Gottingen, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Gottingen, Gottingen, Germany. FAU - Pieske, Burkert AU - Pieske B AD - Department of Internal Medicine and Cardiology, Charite-Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. AD - Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany. FAU - Zapf, Antonia AU - Zapf A AD - Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. FAU - Edelmann, Frank AU - Edelmann F AD - Department of Internal Medicine and Cardiology, Charite-Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. LA - eng GR - German Federal Ministry of Education and Research/International PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20200127 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 RN - 0 (Mineralocorticoid Receptor Antagonists) SB - IM MH - Aged MH - Austria MH - Female MH - Germany MH - *Heart Failure/drug therapy MH - Humans MH - Male MH - Mineralocorticoid Receptor Antagonists MH - Prospective Studies MH - Stroke Volume MH - Ventricular Function, Left PMC - PMC7261555 OTO - NOTNLM OT - Economic costs OT - Economics OT - Heart failure OT - Heart failure with preserved ejection fraction COIS- None declared. EDAT- 2020/01/28 06:00 MHDA- 2021/06/22 06:00 PMCR- 2020/01/27 CRDT- 2020/01/28 06:00 PHST- 2019/08/15 00:00 [received] PHST- 2019/12/02 00:00 [revised] PHST- 2019/12/09 00:00 [accepted] PHST- 2020/01/28 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/01/28 06:00 [entrez] PHST- 2020/01/27 00:00 [pmc-release] AID - EHF212606 [pii] AID - 10.1002/ehf2.12606 [doi] PST - ppublish SO - ESC Heart Fail. 2020 Jun;7(3):786-793. doi: 10.1002/ehf2.12606. Epub 2020 Jan 27.