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The incidence of heart failure in the United States is on the rise. According to the American Heart Association, over 6.5 million Americans have been diagnosed with heart failure and each year more than half a million more cases arise. By 2030, the costs associated with heart failure are projected to reach $70 billion.

Heart failure is a leading cause of hospitalizations and readmissions, particularly among the elderly. This is a major concern for value-based care organizations and Medicare Advantage plans alike. 

As the healthcare sector evolves toward alternative payment models that include financial risk, it will be essential for at-risk organizations to implement strategies that increase the quality of patient care, while also mitigating high-cost utilization. This means finding tools and solutions that effectively minimize acute care in the ER or hospital setting for patients with cardiovascular diseases like heart failure. 

Traditional methods for diagnosing heart failure have significant limitations

The gold standard hemodynamic definition of heart failure is elevated left ventricular filling pressure.1-3 Historically, obtaining this measurement has required an invasive cardiac catheterization procedure that is performed at a specialist care center or in-patient setting. 

This approach presents multiple challenges for both patients and providers. The invasive nature of the procedure means that it isn’t suitable as a frontline heart failure screening tool. In addition, cardiac catheterizations usually require a referral. Many cath labs are booked for weeks or months into the future. As an alternative, clinicians may suggest that patients first receive an echocardiogram. 

Echocardiograms also face their own challenges in aiding the diagnosis of heart failure. They can be time consuming for trained clinicians to use and often can take more than 30 minutes to complete.4 In addition, echocardiograms are not always reliable in detecting elevated left ventricular end diastolic pressure (LVEDP), the gold standard for determining the presence of heart failure in patients.1-3

Large user variability also limits the effectiveness of echocardiography in detecting even common variables such as ejection fraction.5 When echocardiograms detect ejection fraction, they still may miss 80% of undiagnosed heart failure patients as the vast majority of undiagnosed patients have heart failure with preserved ejection fraction.6 Lastly, echocardiograms can have a negative impact on the patient experience as many patients can be uncomfortable removing clothing for diagnostic testing.

For these procedures, it is common for patients to encounter long wait times for appointments, potentially delaying a heart failure diagnosis until their disease progression has reached a more advanced stage.

Social determinants of health (SDOH) also prevent many older patients from pursuing the traditional gold standard for heart failure diagnosis. Limited access to transportation can make it difficult for people to get to multiple appointments. The cost of cardiac catheterizations and echocardiograms may also be prohibitive for elderly people on fixed incomes. Patients on Medicare routinely bear responsibility for 20 percent of the cost of these tests, which could be at least $400 for an echocardiogram and more for cardiac catheterization. 

It’s time to move heart failure diagnostic testing out of the ER and inpatient settings

The healthcare sector needs to provide clinicians with solutions to diagnose heart failure in the home health or clinical outpatient environment. If patients receive noninvasive heart failure testing at home or in a clinic, this will help mitigate the high costs associated with emergency department or inpatient utilization.

With Ventric Health’s Vivio System, clinicians can test patients at risk of heart failure in less than five minutes. This diagnosis-enabling solution detects elevated LVEDP, allowing organizations to change the timelines associated with heart failure identification. Vivio’s cost-effective testing allows clinicians and at-risk organizations to deploy interventions earlier to help reduce costs and improve outcomes, regardless of SDOH barriers. 

Conclusion

Although heart failure care continues to improve, the quality of that care varies greatly across providers and health plans. The key to better outcomes is delivering accessible, patient-centered care and diagnosing heart failure before it becomes a late-stage condition. Leading risk-bearing organizations recognize the value of solutions that reduce barriers to care for all patients, while improving health and financial outcomes. 

Sources:

  1. Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nature Reviews Cardiology. 2020;17:559573.
  2. Pieske B, Tschöpe C, De Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M and Lam CS. How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European heart journal. 2019;40:3297-3317.
  3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J and Chioncel O. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2021;42:3599-3726.
  4. Kimura, Bruce J, and Anthony N DeMaria. “Time Requirements of the Standard Echocardiogram: Implications Regarding Limited Studies.” Journal of the American Society of Echocardiography, vol. 16, no. 10, Oct. 2003, pp. 1015–1018, https://doi.org/10.1016/s0894-7317(03)00590-x. Accessed 18 Apr. 2022.
  5. Foley TA, Mankad SV, Anavekar NS, et al. Measuring Left Ventricular Ejection Fraction – Techniques and Potential Pitfalls. European Cardiology Review. 2012;8(2):108. doi:https://doi.org/10.15420/ecr.2012.8.2.108
  6. Lancellotti P, Galderisi M, Edvardsen T, et al. Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. European Heart Journal - Cardiovascular Imaging. 2017;18(9):961-968. doi:https://doi.org/10.1093/ehjci/jex067