Ultrafiltration for acute decompensated heart failure: cost, reimbursement, and financial impact.
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TLDR
The impact of these various factors is analyzed to better understand how the intensity (and expense) of pharmaceutical and extracorporeal therapies impacts a single admission, as well as to serve as the basis for developing strategies for optimizing long‐term care.Abstract:
In addition to the proposed pathophysiologic mechanisms whereby ultrafiltration (UF) can be advantageous over diuretics in the treatment of heart failure, there can also be financial and resource-utilization reasons for pursuing this extracorporeal strategy. In those cases in which the clinical outcomes would be equivalent, however, the decision whether to pursue UF will depend greatly on the anticipated hospitalization length of stay (LOS), the patient population's pay or mix, the needs and costs for high-acuity (eg, intensive care unit) care, and widely varying expenses for the equipment and disposable supplies. From a fiscal perspective, the financial viability of UF programs revolves around how improvements in LOS, resource utilization, and readmissions relate to the typical diagnosis-driven (eg, diagnosis-related group) reimbursement. We analyzed the impact of these various factors so as to better understand how the intensity (and expense) of pharmaceutical and extracorporeal therapies impacts a single admission, as well as to serve as the basis for developing strategies for optimizing long-term care.read more
Citations
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TL;DR: While extracorporeal ultrafiltration is an appealing therapeutic option for patients with acute decompensated HF, determining the optimal fluid removal rate and the impact on renal function need further investigation.
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Ultrafiltration for acute decompensated heart failure: financial implications.
TL;DR: A summary of the relevant pathophysiological mechanisms such as removal of inflammatory cytokines are provided that might indeed be associated with a number of financial implications for ultrafiltration.
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References
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Journal ArticleDOI
Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure.
Maria Rosa Costanzo,Maya Guglin,Mitchell T. Saltzberg,Mariell Jessup,Bradley A. Bart,John R. Teerlink,Brian E. Jaski,James C. Fang,Erika D. Feller,Garrie J. Haas,Allen S. Anderson,Michael P. Schollmeyer,Paul A. Sobotka +12 more
TL;DR: In decompensated HF, ultrafiltration safely produces greater weight and fluid loss than intravenous diuretics, reduces 90-day resource utilization for HF, and is an effective alternative therapy.
Journal ArticleDOI
Fluid overload in acute heart failure--re-distribution and other mechanisms beyond fluid accumulation.
TL;DR: This paper elaborate on this possible pathophysiological mechanism of fluid overload, its potential causes and amplifiers, and review its potential Causes and Amplifiers.
Journal ArticleDOI
Early ultrafiltration in patients with decompensated heart failure and diuretic resistance.
TL;DR: In heart failure patients with volume overload and diuretic resistance, ultrafiltration before IV diuretics effectively and safely decreases length of stay and readmissions and clinical benefits persist at three months.
Journal ArticleDOI
Epidemiology of acute heart failure syndromes
TL;DR: The poor, short, and medium term prognosis for acute heart failure is underlined, especially for the most severe patients admitted to an intensive care unit, with in-hospital mortality of 28%.
Journal ArticleDOI
Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: results from UNLOAD.
TL;DR: Removal of isotonic fluid by UF compared with hypotonic urine by diuretics more effectively reduces total body sodium in congested HF patients.
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