Clinical and Cost Effectiveness between Treatment Methods of Hyponatremia in Acute Decompensated Heart Failure
Author : S. P. Sirait, N. Hersunarti, H. Andriantoro, R. Soerarso, B. B. Siswanto
Upload Date : 19-04-2018
Background: Hyponatremia is found in 15-20% of hospital admissions and is associated with adverse outcomes in patients with heart failure. The use of aquaretics, which can increase free water excretion without electrolyte loss, may be considered for its management. Adverse outcomes due to hyponatremia also affects health funding, and this is a potential target for intervention to decrease health expenses. This study aims to evaluate the clinical effectiveness of treatment methods of hyponatremia in heart failure and analyze the associated medical costs.
Methods: This is a cross sectional study on acute decompensated heart failure patients with hyponatremia from January 2014 - May 2017. Clinical and medical cost data were acquired from medical records.
Results: 128 subjects were analyzed, with 71 (55.5%) subjects receiving conventional therapy added with AVP receptor antagonist and the rest receiving conventional therapy only. There was a significant difference (p = 0.041) in sodium increase after three days of therapy (median of 4 (-8 – 26) in patients receiving AVP receptor antagonist and 3 (-16 – 16) in those without), and also in length of stay (median of 10.50 (3-40) days in patients receiving AVP receptor antagonist and 6 (3-71) days in those without, p < 0.0001). The variable with the biggest correlation with length of stay is day of AVP receptor antagonist initiation (p < 0.0001). Partial cost analysis showed no significant difference in average daily cost with addition of AVP receptor antagonist.
Conclusion: There is a significant difference in sodium increase and in length of stay between those receiving AVP receptor antagonist and those without AVP receptor antagonist in acute decompensated heart failure patients with hyponatremia. There is no significant difference in cost with the addition of AVP receptor antagonist.
KEYWORDS : hyponatremia, acute decompensated heart failure, AVP receptor antagonist, health cost analysis