Some severe heart failures, including Heart Failure with Preserved Ejection Fraction (HFpEF), should be upgraded to the specialized treatment disease group, or Group A, experts said Tuesday.
Severe heart failures, which require treatment at a tertiary general hospital, are now classified as the general care disease group, or Group B. Even if the disease is treated, however, it is inevitably marginalized in terms of treatment environment, such as personnel support, due to lack of policy support, they pointed out.
The Korean Society of Heart Failure (KSHF) and the National Assembly's Healthcare Development Research Committee held a news conference highlighting the problems with the heart failure patient classification system and calling for upgrading the classification of severe heart failure disease.
Korea's patient classification system is divided into specialized care groups (Group A), general care groups (Group B), and simple care groups (Group C) according to the disease’s severity. However, heart failure patients are tied up in Group B regardless of their severity, making it difficult for high-level general hospitals to treat them.
"Heart failure is a severe disease that causes repeated deterioration, resulting in hospitalization, premature death, poor quality of life, and rising medical costs, but it is classified as a Group B disease, creating many irrationalities in the care of heart failure patients," said Dr. Cho Sang-ho, a professor of cardiology at Hallym University Sacred Heart Hospital.
Professor Cho added that the more Group A patients a hospital sees, the more highly it will be evaluated and rated as a tertiary general hospital, which affects medical reimbursement and hospital revenue. So, Cho said Group A diseases receive more attention and support within the hospital.
"Heart failure is a disease with a poor prognosis, with a five-year mortality rate of 50 percent, similar to lung cancer. Proper management and treatment is very important, but it is not included in Group A, which is a disadvantage for heart failure treatment and management," said Dr. Kang Seok-min, the KSHF chair and a professor of cardiology at Severance Hospital.
Kang noted that as the elderly population increases, so does the prevalence of hypertension and diabetes, all of which are precursors to heart failure. The number of patients with severe heart failure is expected to increase in the next 10 years. However, since the severity of the disease is lower in tertiary general hospitals, various supports, including manpower support, are bound to decrease.
“Moreover, heart failure is characterized by repeated hospitalization. From next year, however, hospitalization subsidies for internal medicine will be removed. Echocardiograms are also used to evaluate heart function, but the imaging test subsidies will also be removed. I think it's unfair in that regard," Professor Kang added.
The more severe patients a hospital sees, the more government funding it receives, so from a management perspective, it is inevitable that they will be passive in supporting manpower and infrastructure for heart failure treatment (currently rated B), Kang pointed out
“I am concerned that the heart failure treatment system will be devastated," he added.
KSHF emphasized that instead of including all heart failure patients in Group A, some severe cases of heart failure, such as heart failure with pulmonary edema and acute heart failure, which require emergency intensive care unit treatment or expensive medications, should be upgraded to a higher classification system and treated at a senior general hospital.
"The rapid increase in the prevalence of heart failure is a serious problem as we approach a superaged society. Due to the high number of hospitalizations, medical expenses have increased by more than 60 percent. We need realistic measures for heart failure, but patients are suffering due to the lack of attention," Professor Cho said. "It is necessary to upgrade the classification to severe, at least for those requiring ICU treatment."
Dr. Choi Jin-oh, a professor of cardiology at Samsung Medical Center and executive for general affairs at KSHF, said, "Even now, they recognize heart failure as a specialty disease group if they require costly and invasive tests, leading to more unnecessary tests. In Korea, the government manages and controls healthcare policy. If the policy is wrong, the treatment is bound to go in the wrong direction."
Professor Kang said, "Heart failure has a relatively poor prognosis but can be managed well if treated properly. If heart failure is categorized as group A, it can greatly contribute to improving patient prognosis. KSHF is also striving to educate the public about it."