The cost-effective way forward for the management of the patient with heart failure

Heart failure is a huge healthcare issue not only for clinicians but for healthcare managers also, with increasing pressure to demonstrate the cost-effectiveness of therapies especially for common chronic conditions. The cost-effectiveness of heart failure treatments relate to their effects on the progression of the disease, the associated quality of life for the patient, and the actual cost of the disease management. Direct costs are usually associated with hospitalization. Indirect costs, such as the loss of production through absence from work, are more difficult to determine. Studies such as CONSENSUS, SOLVD, SAVE and the Munich Heart Failure trial have all shown that angiotensin-converting enzyme inhibitors offer effective therapy in all these aspects. Nonpharmacological strategies that have also been shown to favorably influence both the costs and benefit include the addition of a nurse practitioner to assist in patient management.