Program theory and economic insights of a comprehensive geriatric assessment for frail heart failure patients

Abstract

Background: To address frailty in chronic heart failure (HF) outpatients, we recently launched the Heart-Brain Clinic where we conduct comprehensive geriatric assessments (CGA). Its effectiveness has not yet been evaluated. The aim of this study is to explore how and why the CGA may impact quality of life and costs in selected HF outpatients. Methods: A mixed methods approach was used. First, we developed the program theory of the CGA by combining semi-structured interviews and literature, focusing on the ‘interventions’ and ’outcomes’ expected to result from the CGA. Second, we estimated the current costs of those expected outcomes to depict the room for improvement if all outcomes would be prevented. Costs were calculated with literature data and a prospective Dutch cohort study, adjusted for 2023 inflation. Results: The program theory indicated that recommended interventions were diverse, spanning both health and social domains. Stakeholders anticipated interventions addressing mood disorders, loneliness, and impaired mobility would most effectively improve quality of life and reduce healthcare costs, alleviating depressive symptoms and preventing falls. Improved quality of life and cost savings could also result from fewer acute HF events and less caregiver burden, with current per-patient yearly costs ranging from €1 111–2 111 for depressive symptoms, €289-3 266 for falls, and €4 048 − 6 940 for HF events. Conclusions: The developed program theory identifies essential data to collect for evaluating the CGA’s (cost-) effectiveness. In addition, it shows the high current costs of outcomes that a CGA could impact, indicating room for improvement in costs.