Primary causes and direct medical cost of heart failure among adults admitted with acute decompensated heart failure in a public tertiary hospital, Kenya

Heart failure (HF) is a major contributor of cardiovascular morbidity and mortality globally. Despite its adverse impact on health outcomes in low- and middle-income countries such as Kenya, data on the direct medical cost of HF hospitalization is limited. This was a prospective study conducted at Moi Teaching and Referral Hospital. Patients with HF were identified by sequential medical chart abstraction. Primary causes were extracted from echocardiogram reports and adjudicated by a cardiologist. Direct medical cost of hospitalization was derived using activity-based costing, micro-costing method, and payers’ system perspective. Drivers of overall cost were explored using linear regression models. 142 participants were consecutively recruited from September to November 2022. 51.4% were females, and the overall mean age was 54 (SD 20). The leading primary cause was cor pulmonale (CP), 28.9%; then dilated cardiomyopathy (DCM), 26.1%; rheumatic heart disease (RHD), 19.7%; hypertensive heart disease (HHD), 16.9%; ischaemic heart disease (IHD), 6.3%; and pericardial disease (PD), 2.1%. Overall direct cost of HF hospitalization was Kshs. 11,470.94 (SD 8,289.57) per patient per day, with the mean length of hospital stay of 10.1 (SD 7.1). RHD incurred the highest costs, Kshs. 15,299.08 (SD 13,196.89) per patient per day, then IHD, Kshs. 12,966.47 (SD 6656.49), and DCM, Kshs.12,268.08 (SD 7,816.12). Cost of medications was the leading driver, β = 0.56 (0.55 – 0.56), followed by inpatient fees, β = 0.27 (0.27 – 0.28) and laboratory investigations, β = 0.19 (0.18 – 0.19). Cor pulmonale, CM, RHD and HHD were the major causes of HF. The overall direct medical cost of hospitalization was extremely expensive compared with the average monthly household income per capita in Kenya. Widespread insurance cover is therefore recommended to cushion families against such catastrophic health expenditures beside public health measures aimed at addressing primary causes of HF. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding was obtained for this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Moi University Institutional Research Ethics Committee (approval number 003738 and reference number IREC/2020/187). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data used in this study is available for sharing upon reasonable request to the corresponding author.