Clin Res Cardiol 97- Suppl 1
V1772 - Impact of different stages of left ventricular dysfunction on in-hospitial costs in patients with coronary heart disease
 
W. Stepper1, D. Kiski1, H. Bunzemeier2, L. Siebers2, G. Breithardt1, N. Roeder2, H. Reinecke1
 
1Medizinische Klinik und Poliklinik C, Universitätsklinikum Münster, Münster; 2Geschäftsbereich Medizinisches Management, Universitätsklinikum Münster, Münster
 
Introduction: Left ventricular (LV) systolic dysfunction is well known to be associated with markedly increased in-hospital morbidity and mortality. However, its effect on in-hospital costs when treating patients with coronary heart disease (CHD) has not been assessed which appears to be of interest due to both, its missing implementation in the German reimbursement system, and the continuous increase in affected patients.
Methods: Clinical and costing data were assessed from 694 consecutive patients at our institution who underwent percutaneous coronary interventions (PCI) due to significant CHD. Patient-level in-hospital costs were thoroughly calculated from precise in-house assessments for the national diagnosis related groups (DRG) database on which health system reimbursements are based in Germany. LV function was classified in 3 stages depending on the ejection fraction in accordance to other studies (EF>59% =normal, EF<60% and >35% = moderately reduced, EF<35% =severely reduced)
Results: With each decline in LV function, univariate linear regression found a significant and marked increase in in-hospital costs (Figure, p<0.001). Other predictors of higher in-hospital cost were age>75 years (p=0.014), three-vessel disease (p<0.001), acute myocardial infarction (p=0.008), higher creatinine (p<0.001), lower body mass index (p=0.004), angiographically detected thrombus (p<0.001), bypass PCI (p<0.001), and PCI of a high risk lesion (p=0.018). However, after adjustment for these other significant predictors by multivariate analyses using logistic regression analyses, LV function remained an independent predictor of in-hospital costs (p<0.001).
Conclusions: These data show for the first time that reduced LV function is an important predictor of in-hospital costs in PCI patients. At present,  LV function has not been implemented in the German DRG system, and moreover, even the clinical diagnosis left heart failure leads no longer to higher reimbursement due to substantial changes in the DRG system 2008.

   

 

Figure legend: Mean in-hospital treatment costs and 95% confidence intervals depending on different stages of  reduced LV function
 

http://www.abstractserver.de/dgk2008/ft/abstracts/V1772.htm