Incremental Burden of Congestive Heart Failure among Elderly with Alzheimer's

Background: We assessed the health resource utilization (HRU) and cost of care in elderly with Alzheimer's disease (AD) and with or without concomitant congestive heart failure (CHF).

Research Design: A retrospective study.

Setting: Elderly (65 years or older) patients from an urban academic healthcare system.

Subjects: All elderly diagnosed with AD in 1999 (n=904) and matched AD free controls (n=3,616).

Measurements: Each group was subdivided into those with and without CHF diagnosis. Costs and HRU were obtained from Medicare database for 1999 and 2000. A propensity scores were used to minimize the selection bias. Cost and HRU were compared using ANOVA and Wilcoxon rank sum test. Regressions were used to model the effect on AD and CHF on outcomes.

Results: Mean and median costs over 2-year period were different across the groups. Mean cost were $17,121 for AD with CHF group, $3121 for the AD and non-CHF group, $14508 for non-AD with CHF group and $3334 for non-AD and non-CHF group. After adjusting for propensity score, AD with CHF group had eight- fold increase in costs, while the non-AD with CHF group had five-fold increases in costs, compared to the non-AD and non-CHF group. Regression results for inpatient costs, outpatient costs and inpatient pharmacy costs exhibited similar trends.

Conclusions: For elderly AD patients, a co-occurring diagnosis of CHF can result in substantial increase HRU and lower quality of care. Thus, a diagnosis of AD should be followed by a multidisciplinary evaluation for CHF and other comorbidities for effective AD care.