scholarly journals Show Me the Money

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Neal W. Dickert ◽  
Andrea R. Mitchell ◽  
Grace E. Venechuk ◽  
Daniel D. Matlock ◽  
Miranda A. Moore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Ejection Fraction ◽  
Decision Aid ◽  
Descriptive Analysis ◽  
Patient Specific ◽  
Specific Cost ◽  
Reduced Ejection Fraction ◽  
Medication Costs ◽  
Out Of Pocket Costs

Background: Out-of-pocket medication costs for patients who have heart failure with reduced ejection fraction may be an important part of shared decision-making, but cost has generally been excluded from clinical discussions. This study reports patients’ perspectives on a decision aid for sacubitril/valsartan that explicitly addresses out-of-pocket costs. Methods: Structured, in-depth interviews were conducted with 20 patients with heart failure with reduced ejection fraction from 2 medical centers to elicit their views on a publicly available decision aid for sacubitril/valsartan that explicitly incorporates considerations related to out-of-pocket costs. Qualitative descriptive analysis was conducted. Results: Key themes identified were general enthusiasm for decision aids for medication decisions, openness on the part of patients to incorporation of cost into decision-making and the decision aid, requests for greater specificity regarding patient-specific cost, and challenges communicating evidence of benefit in a way that allows patients to make cost-benefit analyses for themselves. Patients also raised questions regarding logistical challenges of incorporating a decision aid into the normal clinical and decision-making workflow. Conclusions: Patients were receptive to the inclusion of out-of-pocket cost as relevant in a decision aid for sacubitril/valsartan. Key challenges to effective integration of cost in these decisions include developing mechanisms for acquiring reliable patient-specific cost estimates and addressing patients’ difficulties (and sometimes skepticism) applying trial evidence to their own situation. In addition, implementation strategies are important to develop to facilitate decision aid integration for routine medical decisions into clinic workflow.

Abstract 21: Heart Failure and Shared Decision-making: Patients’ Perspectives Regarding Medication-related Cost Discussions

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Birju Rao ◽  
Neal W Dickert ◽  
Alanna A Morris ◽  
Candace Speight ◽  
Graham Smith ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Financial Burden ◽  
Descriptive Analysis ◽  
Cost Benefit ◽  
Patient Specific ◽  
Medication Cost ◽  
Eligibility Criteria ◽  
Reduced Ejection Fraction ◽  
Medication Costs

Background: Patients with heart failure with reduced ejection fraction (HFrEF) take on average 6 medications daily and can face considerable out-of-pocket medication costs. This issue has become particularly salient as newer medications such as sacubitril-valsartan have emerged as beneficial. As clinicians attempt to maximize benefits for this population, discussions of medication costs between patients and clinicians are critical. However, cost discussions are known to be infrequent and often suboptimal. Objective: To explore patients’ perspectives on discussing out-of-pocket medication costs with clinicians. Methods: 49 adults, aged 44-70, with HFrEF meeting general eligibility criteria for sacubitril-valsartan were recruited from outpatient heart failure clinics and inpatient services. Descriptive quantitative analysis of closed-ended and multiple-choice responses was conducted. Qualitative descriptive analysis of open-ended text data was performed. Results: About half (49%) of participants reported any previous discussion with clinicians about out-of-pocket cost related to medication. These participants described their experience with cost discussions at the time of prescription as generally positive. Specific ways these discussions were helpful included clarifying cost-benefit tradeoffs and identifying opportunities for cost reduction. Most participants (96%) were open to cost discussions with their clinician, and many (69%) specifically preferred that clinicians initiate discussions regarding medication cost. There were no differences in cost discussion preferences between participants who employed different decision-making approaches about initiation of sacubitril-valsartan or across levels of financial burden. Conclusion: Out-of-pocket cost is a relevant component of patient-centered medical decisions, particularly for patients with HFrEF. These data suggest patients with HFrEF are receptive to incorporating cost discussions into care and identify some of the ways these discussions may be helpful. Further research is needed to clarify how best to identify patient-specific cost at the time of clinical encounters and how to work with patients to make cost-benefit assessments.

Abstract 27: Patients' Perspectives on a Decision Aid to Facilitate Cost-sensitive Decisions for Sacubitril-Valsartan

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andrea R Mitchell ◽  
Grace Venechuk ◽  
Larry A Allen ◽  
Dan D Matlock ◽  
Miranda Moore ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Descriptive Analysis ◽  
Patient Specific ◽  
Shared Decision ◽  
Cost Information ◽  
Reduced Ejection Fraction ◽  
The Impact

Background: Decision aids frequently focus on decisions that are preference-sensitive due to an absence of superior medical option or qualitative differences in treatments. Out of pocket cost can also make decisions preference-sensitive. However, cost is infrequently discussed with patients, and cost has not typically been considered in developing approaches to shared decision-making or decision aids. Determining a therapy’s value to a patient requires an individualized assessment of both benefits and cost. A decision aid addressing cost for sacubitril-valsartan in heart failure with reduced ejection fraction (HFrEF) was developed because this medication has clear medical benefits but can entail appreciable out-of-pocket cost. Objective: To explore patients’ perspectives on a decision aid for sacubitril-valsartan in HFrEF. Methods: Twenty adults, ages 32-73, with HFrEF who met general eligibility for sacubitril-valsartan were recruited from outpatient HF clinics and inpatient services at 2 geographically-distinct academic health systems. In-depth interviews were conducted by trained interviewers using a semi-structured guide after patients reviewed the decision aid. Interviews were audio-recorded and transcribed; qualitative descriptive analysis was conducted using a template analytic method. Results: Participants confirmed that cost was relevant to this decision and that cost discussions with clinicians are infrequent but welcomed. Participants cited multiple ways that this decision aid could be helpful beyond informing a choice; these included serving as a conversation starter, helping inform questions, and serving as a reference later. The decision aid seemed balanced; several participants felt that it was promotional, while others wanted a more “positive” presentation. Participants valued the display of benefits of sacubitril-valsartan but had variable views about how to apply data to themselves and heterogenous interpretations of a 3% absolute reduction in mortality over 2 years. None felt this benefit was overwhelming; about half felt it was very small. The decision aid incorporated a novel “gist statement” to contextualize benefits and counter tendencies to dismiss this mortality reduction as trivial. Several participants liked this statement; few had strong impressions. Conclusion: Out of pocket cost should be part of shared decision-making. These data suggest patients are receptive to inclusion of cost in decision aids and that a “middle ground” between being promotional and negative may exist. The data, however, raise concerns regarding potential dismissal of clinically meaningful benefits and illustrate challenges identifying appropriate contextualizing language. The impact of various framings warrants further study, as does integration of decision aids with patient-specific out-of-pocket cost information during clinical encounters.

scholarly journals Heart Failure and Shared Decision-Making: Patients Open to Medication-Related Cost Discussions

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Birju R. Rao ◽  
Neal W. Dickert ◽  
Alanna A. Morris ◽  
Candace D. Speight ◽  
Graham H. Smith ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Financial Burden ◽  
Medication Cost ◽  
Patient Centered ◽  
Reduced Ejection Fraction ◽  
Medication Costs ◽  
Related Cost ◽  
Patients With Heart Failure ◽  
Centered Care

Background: Discussions of medication costs between patients and clinicians are infrequent and often suboptimal. In the context of recently introduced drugs that are effective but expensive, patients with heart failure with reduced ejection fraction provide an ideal population to understand the perspectives of patients with chronic illness on medication cost and cost discussions. Methods: To explore patients’ perspectives on discussing out-of-pocket medication costs with clinicians, 49 adults, aged 44 to 70 years, with heart failure with reduced ejection fraction were recruited from outpatient heart failure clinics. Descriptive qualitative analysis was performed on open-ended text data. Results: Participants who had prior medication-related cost discussions described their experience as generally positive, but about half of the participants had never had a cost discussion with their clinician. Most participants were open to cost discussions with clinicians and preferred that the clinician initiate discussions regarding medication cost. Importantly, these preferences held constant across reported levels of financial burden. Conclusions: These data suggest a substantial willingness on the part of patients with heart failure with reduced ejection fraction to incorporate cost discussions into their care and identify important aspects of these discussions for clinicians to consider when engaging in conversations where cost is relevant. Improving understanding about how to integrate patient preferences regarding cost discussions into clinical encounters is an important priority for advancing patient-centered care.

Heart Failure with Preserved Ejection Fraction – A Review

2012 ◽  
Vol 9 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Otto A Smiseth ◽  
Anders Opdahl ◽  
Espen Boe ◽  
Helge Skulstad
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Heart Failure ◽  
The Elderly ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Objective Evidence

Heart failure with preserved left ventricular ejection fraction (HF-PEF), sometimes named diastolic heart failure, is a common condition most frequently seen in the elderly and is associated with arterial hypertension and left ventricular (LV) hypertrophy. Symptoms are attributed to a stiff left ventricle with compensatory elevation of filling pressure and reduced ability to increase stroke volume by the Frank-Starling mechanism. LV interaction with stiff arteries aggravates these problems. Prognosis is almost as severe as for heart failure with reduced ejection fraction (HF-REF), in part reflecting co-morbidities. Before the diagnosis of HF-PEF is made, non-cardiac etiologies must be excluded. Due to the non-specific nature of heart failure symptoms, it is essential to search for objective evidence of diastolic dysfunction which, in the absence of invasive data, is done by echocardiography and demonstration of signs of elevated LV filling pressure, impaired LV relaxation, or increased LV diastolic stiffness. Antihypertensive treatment can effectively prevent HF-PEF. Treatment of HF-PEF is symptomatic, with similar drugs as in HF-REF.

Evaluation of the Efficacy of ST2 and NT-proBNP in the Diagnosis and Prediction of Short- Term Prognosis in Heart Failure with Reduced Ejection Fraction

2017 ◽  
Vol 9 (04) ◽  
Author(s):  
Shivananda B Nayak ◽  
Dharindra Sawh ◽  
Brandon Scott ◽  
Vestra Sears ◽  
Kareshma Seebalack ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Biomarkers ◽  
Double Blind Study ◽  
Short Term ◽  
Double Blind ◽  
Reduced Ejection Fraction ◽  
The Mean ◽  
Design And Methods ◽  
The Relationship

Purpose: i) To determine the relationship between the cardiac biomarkers ST2 and NT-proBNP with ejection fraction (EF) in heart failure (HF) patients. ii) Assess whether a superiority existed between the aforementioned cardiac markers in diagnosing the HF with reduced EF. iii) Determine the efficacy of both biomarkers in predicting a 30-day cardiovascular event and rehospitalization in patients with HF with reduced EF iv) To assess the influence of age, gender, BMI, anaemia and renal failure on the ST2 and NT-proBNP levels. Design and Methods: A prospective double-blind study was conducted to obtain data from a sample of 64 cardiology patients. A blood sample was collected to test for ST2 and NT-proBNP. An echocardiogram (to obtain EF value), electrocardiogram and questionnaire were also obtained. Results: Of the 64 patients enrolled, 59.4% of the population had an EF less than 40%. At the end of the 30- day period, 7 patients were warded, 37 were not warded, one died and 17 were non respondent. Both biomarkers were efficacious at diagnosing HF with a reduced EF. However, neither of them were efficacious in predicting 30-day rehospitalization. The mean NT-proBNP values being: not rehospitalized (2114.7486) and 30 day rehospitalization (1008.42860) and the mean ST2 values being: not rehospitalized (336.1975), and 30-day rehospitalization. (281.9657). Conclusion: Neither ST2 or NT-proBNP was efficacious in predicting the short- term prognosis in HF with reduced EF. Both however were successful at confirming the diagnosis of HF in HF patients with reduced EF.

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