Heart failure patients face up to $30K in out-of-pocket costs

In marking Heart Failure Awareness Week (22–28 June), new analysis has highlighted the out-of-pocket burden of heart failure, estimating costs of up to almost $30,000 in the first year following diagnosis.

Heart failure affects around half a million Australians, with approximately 67,000 new diagnoses and 158,000 hospital admissions each year. Many people living with the condition are also managing a cluster of related comorbidities, including kidney disease, type 2 diabetes, high blood pressure, obesity and mental health conditions.

According to patient advocacy organisation Hearts4heart, annual costs associated with managing heart failure may reach up to $18,000, increasing to as much as $29,000 for individuals also living with chronic kidney disease.

The estimates are drawn from a first-of-its-kind patient-focused cost analysis designed to capture the broader financial impact of heart failure and reinforce the importance of earlier detection and coordinated care. The modelling is based on a set of core assumptions, including an adult with a Medicare card living in a major city, primarily using the public health system, and paying some out-of-pocket costs for their treatment and ongoing management.

“The cost of managing heart failure can be significant, which is why early detection is so important. The sooner people understand their risk, the sooner they can access care and support to help manage their health,” said Tanya Hall, CEO and founder of Hearts4heart.

Patients face a range of out-of-pocket costs, including GP and specialist visits, diagnostic testing, medicines, cardiac rehabilitation and allied healthcare, as well as expenses for medical equipment, transport and parking. Indirect costs can also add up, such as time off work and the unpaid time and support provided by carers, alongside mobility aids and other ongoing care needs.

Professor Andrew Sindone, Director of the Heart Failure Unit and Department of Cardiac Rehabilitation at Concord Hospital and Head of Department of Cardiology at Ryde Hospital, said earlier detection is essential.

“Heart failure can be difficult to recognise as symptoms can develop gradually, or be mistaken for other conditions. The good news is there are tests and routine checks that can help healthcare professionals identify risk earlier,” said Professor Sindone.

“For people living with connected conditions such as kidney disease, diabetes or high blood pressure, it is especially important to speak with a GP or healthcare professional about what checks may be appropriate for you. Early detection is an important part of improving patient outcomes and helping to minimise the financial burden associated with managing heart failure,” he added.

Chris Forbes, CEO of Kidney Health Australia, said strengthening awareness of the heart–kidney connection remains critical to improving outcomes.

“Kidney disease can be silent for a long time, and many people may not know they are living with it until it has progressed,” explained Forbes. “For people with heart failure, or those at risk of heart failure, understanding kidney health is an important part of the overall picture.”

In related developments that may impact heart failure risk, emerging evidence is drawing attention to lipoprotein(a) [Lp(a)] which is linked to atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. Findings from a news study reveal that over the past decade Lp(a) testing in Australia has increased substantially, rising from 2,686 tests in 2015 to 23,135 in 2024.

The expansion of clinical guidelines alongside new therapies capable of reducing lipoprotein(a) [Lp(a)] by approximately 80%–100%, has contributed to renewed clinical interest in the biomarker. Pelacarsen is an antisense oligonucleotide, while muvalaplin is a small molecule that inhibits the assembly of Lp(a). In contrast, olpasiran, zerlasiran and lepodisiran are small interfering RNA (siRNA) therapies. These agents act by suppressing mRNA production from the LPA gene, which encodes apolipoprotein(a), thereby lowering circulating Lp(a) concentrations.

Randomised trials for pelacarsen (Lp[a] HORIZON), olpasiran (OCEAN[a] trial), and lepodisiran (ACCLAIM-Lp[a] trial) are underway with outcomes reported in the not-too-distant future. If these trials demonstrate that Lp(a)-lowering agents reduce ASCVD burden, MBS-funded testing for Lp(a) will become even more important.

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