Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure

2022 ◽  
Author(s):  
Emily P. Zeitler ◽  
Andrea M. Austin ◽  
Christopher G. Leggett ◽  
Lauren G. Gilstrap ◽  
Daniel J. Friedman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medicare Beneficiaries ◽  
Complications And Mortality

Abstract 18020: Identifying Hospitalizations Related to Heart Failure in Dronedarone Users Who Are Supplementary Medicare Beneficiaries

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chuntao Wu ◽  
Andrew Koren ◽  
Jane Thammakhoune ◽  
Jasmanda Wu ◽  
Hayet Kechemir ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Claims Data ◽  
Search Algorithm ◽  
Medicare Beneficiaries ◽  
Current Procedural Terminology ◽  
Diagnosis Codes ◽  
Medicare Database ◽  
The Impact

Background: When using inpatient claims data to identify hospitalizations in supplemental Medicare beneficiaries, e.g., in the MarketScan database, there is a concern that the coverage of hospitalizations in such inpatient claims may be incomplete. However, whether hospitalizations are covered by inpatient claims or not, they incur professional charges that are recorded in the professional claims data in the MarketScan Medicare database. In the context of identifying hospitalizations that might be related to heart failure (HF) in dronedarone users, we compared different approaches to identify such hospitalizations. Objective: To assess the impact of using professional claims in addition to inpatient claims on identifying hospitalizations that might be related to HF. Methods: A total of 20,834 dronedarone users who were supplemental Medicare beneficiaries between July 2009 (launch date in US) and December 2012 were identified in the MarketScan database. The hospitalizations that might be related to HF within 30 days prior to initiating dronedarone were identified by searching (1) inpatient claims and (2) both inpatient and professional claims using related ICD-9-CM diagnosis codes for HF and Current Procedural Terminology codes for hospitalizations. Results: A total of 1,162 patients who had HF hospitalizations within 30 days prior to initiating dronedarone were identified by searching inpatient claims between July 2009 and December 2012. Supplementing with professional claims identified an additional 177 patients who had HF hospitalizations, increasing the total number to 1,339. Therefore, 13.2% (177/1,399) of the patients who had HF hospitalizations could only be identified in professional claims. Thus, the prevalence of hospitalizations that might be related to HF within 30 days prior to initiating dronedarone was 5.6% (1,162/20,834; 95% confidence interval (CI): 5.3 - 5.9%) when hospitalizations were identified using inpatient claims alone. Adding professional claims in the search algorithm, the prevalence of HF hospitalizations was 6.4% (1,339/20,834, 95% CI: 6.1 - 6.8%). Conclusions: Using professional claims, in addition to inpatient claims, can improve the identification of hospitalizations that might be related to HF.

Abstract 5921: Medicare Beneficiaries with Mild to Severe Heart Failure See 15–23 Different Providers Annually

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Robert L Page ◽  
Christopher Hogan ◽  
Kara Strongin ◽  
Roger Mills ◽  
JoAnn Lindenfeld
Keyword(s):  
Heart Failure ◽  
Severe Heart Failure ◽  
The United States ◽  
Outpatient Setting ◽  
Fiscal Year ◽  
Hospital Inpatient ◽  
Medicare Beneficiaries ◽  
Improvement Program ◽  
Data Set ◽  
Mild Disease

In fiscal year 2003, Medicare beneficiaries with heart failure (HF) accounted for 37% of all Medicare spending and nearly 50% of all hospital inpatient costs. On average, each beneficiary had 10.3 outpatient and 2 inpatient visits specifically for HF. Despite significant improvements in medical care for HF, mortality and hospital admissions remain high. No data exist regarding the number of providers ordering and providing care for this population. An analysis of fiscal year 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. Three cohorts were defined according to mild, moderate, severe HF employing the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model and Chronic Care Improvement Program definitions. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. We identified physicians by using the unique physician identification number of performing physicians. Based on inclusion criteria, 173,863 beneficiaries were identified. The average number of providers providing care in all sites were 15.9, 18.6, 23.1 for beneficiaries with mild, moderate, and severe HF, respectively; and 10.1, 11.5, and 12.1 in the outpatient setting, respectively. The average number of providers ordering care in all sites consisted of 8.3, 9.6, and 11.2 for beneficiaries with mild, moderate, and severe HF, respectively; and 6.5,7.3, and 7.8 in the outpatient setting, respectively. For beneficiaries with mild disease, only 10% of all office visits were specifically for HF, while those with moderate or severe disease, only 20% were specifically for HF. Medicare beneficiaries with HF, even those with mild disease, have a large number of providers ordering and providing care. These data highlight the importance for developing systems and processes of coordinated care for this population.

scholarly journals Readmission Patterns in Medicare Beneficiaries Hospitalized for heart failure

2015 ◽  
Vol 18 (3) ◽  
pp. A277
Author(s):  
M. Kilgore ◽  
P. Sharma ◽  
H. Patel ◽  
J. Maya ◽  
A. Kielhorn
Keyword(s):  
Heart Failure ◽  
Medicare Beneficiaries

Abstract 17143: Shorter Length of Stay is Associated With Significantly Lower 30-day All-cause Readmission and 30-day All-cause Mortality in Older Medicare Beneficiaries Hospitalized for Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cherinne Arundel ◽  
Ali Ahmed ◽  
Rahul Khosla ◽  
Charles Faselis ◽  
Charity Morgan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Prospective Payment System ◽  
Early Discharge ◽  
Continuous Variable ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Medicare Beneficiaries ◽  
Post Discharge ◽  
All Cause Mortality

Background: A shorter hospital length of stay, encouraged by Prospective Payment System Act, may result in suboptimal care and early discharge. Heart failure (HF) is the leading cause for 30-day all-cause readmission. However, it is unknown whether hospitalized HF patients with a shorter length of stay may have higher 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. Methods: The 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001) had a median length of stay of 5 days (interquartile, 4-8 days), of which 4272 (53%) had length of stay ≤ 5 days. Using propensity scores for length of stay 1-5 days, we assembled a matched cohort of 2788 pairs of patients with length of stay 1-5 and ≥6 days, balanced on 32 baseline characteristics. Results: 30-day all-cause readmission occurred in 19% and 23% of matched patients with length of stay 1-5 and ≥6 days, respectively (HR, 0.79; 95% CI, 0.70-0.89; Figure, left panel). When the length of stay of the 8049 pre-match patients was used as a continuous variable and adjusted for the same 32 variables, each day longer hospital stay was associated with a 2% higher risk of 30-day all-cause readmission (HR, 1.02; 95% CI, 1.01-1.03; p<0.001). Among matched patients, HR for 30-day HF readmission associated with length of stay 1-5 days was 0.84 (95% CI, 0.69-1.01; p=0.063). 30-day all-cause mortality occurred in 4.6% and 6.2% of matched patients with length of stay 1-5 and ≥6 days, respectively (HR, 0.73; 95% CI, 0.58-0.91; Figure, right panel). These associations persisted throughout 12 months post-discharge. Conclusions: Among hospitalized patients with HF, length of stay 1-5 days (vs. longer) was associated with significantly lower 30-day all-cause readmissions and all-cause mortality that persisted throughout first year post-discharge.

Abstract P113: Use of Guideline Recommended Therapies for Heart Failure in Outpatient Settings Among Medicare Beneficiaries

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Lisa D DiMartino ◽  
Alisa Shea ◽  
Adrian F Hernandez ◽  
Lesley H Curtis
Keyword(s):  
Heart Failure ◽  
Beta Blocker ◽  
Ace Inhibitor ◽  
Beta Blockers ◽  
Multivariable Analysis ◽  
Community Dwelling ◽  
Drug Coverage ◽  
Self Report ◽  
Medicare Beneficiaries ◽  
Over Time

Background: Most information about the use of guideline recommended therapies for heart failure (HF) is based on what occurs at discharge following an inpatient stay. Using a nationally representative, community-dwelling sample of elderly Medicare beneficiaries, we examined how use of angiotensin-converting enzyme (ACE) inhibitor, angiotensin-receptor blocker (ARB), and beta-blocker therapies has changed over time and factors associated with their use. Methods: We used data from the Medicare Current Beneficiary Survey Cost and Use files matched with Medicare claims to identify beneficiaries for whom a diagnosis of HF was reported from January 1, 2000-December 31, 2004. Medications prescribed during the calendar year of cohort entry were obtained from patient self-report. We used descriptive statistics to examine prescription medication use over time. Multivariable logistic regression was used to explore the relationship between use of an ACE inhibitor/ARB or beta blocker and patient demographics. Results: There were 2,689 unweighted, or 8,288,306 weighted, elderly, community-dwelling Medicare beneficiaries with HF identified. Between 2000 and 2004, the reported use of ARBs increased from 12% (unweighted, 88/725) to 19% (unweighted, 82/421), while use of beta-blockers increased from 30% (unweighted, 215/725) to 41% (unweighted, 170/421). Use of ACE inhibitors remained constant at 45% (unweighted 2000, 329/725; unweighted 2004, 192/421). In multivariable analysis, beneficiaries reporting any prescription drug coverage were 32% (95%CI=1.09-1.59) more likely to have filled a prescription for an ACE inhibitor/ARB and 26% (95%CI=1.03-1.53) more likely to have filled a prescription for a beta-blocker. Compared to beneficiaries diagnosed with HF in 2000, beneficiaries diagnosed in 2004 were 38% (95%CI=1.06-1.79) more likely to have filled a prescription for an ACE inhibitor/ARB and 62% (95%CI=1.23-2.13) more likely to have filled a prescription for a beta-blocker. Conclusion: Although use of guideline recommended therapies for HF has increased over time, their use remains suboptimal. Further efforts are necessary in order to ensure all Medicare beneficiaries have adequate drug coverage for these therapies.

Abstract 2707: The Magnitude of Health Care Resource Utilization by Medicare Beneficiaries with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert L Page ◽  
Kara B Strongin ◽  
Roger M Mills ◽  
Christopher Hogan ◽  
JoAnn Lindenfeld
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
The United States ◽  
Hospital Inpatient ◽  
Medicare Beneficiaries ◽  
Data Set ◽  
Physician Visits ◽  
Hospital Outpatient ◽  
Co Morbidity ◽  
Medicare Spending

Introduction: By 2010, the number of individuals ≥ 65 years with a heart failure (HF) diagnosis should increase by an additional 700,000. As the financial burden of HF is expected to substantially increase, we examined health care expenditures of Medicare beneficiaries with HF to estimate the current healthcare costs and resource allocation. Methods: An analysis of 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. The cohort was defined by the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model which requires one HF diagnosis from a physician or hospital outpatient department/inpatient bill. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. Results: Based on inclusion criteria, 260,076 beneficiaries were identified. Beneficiaries with HF accounted for 13% of the total beneficiary population and 37% of all Medicare spending. Reimbursement for hospital inpatient admissions, physician visits, and hospital outpatient visits accounted for $12,556; $5,875; and $2,753 per-capita, respectively. In one year, 22% of all beneficiaries required hospitalization compared to 59% of beneficiaries with HF. Thirty-one percent of beneficiaries with HF had ≥ 2 inpatient admissions. Twenty-four percent of all hospital discharges were for HF, either as a principal diagnosis or co-morbidity, accounting for $30.4 billion. On average, 8.3 different outpatient and inpatient providers ordered services for a single beneficiary. Beneficiaries with at least two prior HF hospitalizations within the index period had on average 3.04 physician visits every three months. Only 26% of these visits were conducted by a cardiologist. Conclusion : Medicare beneficiaries with HF impose a tremendous burden on Medicare, consisting of over one-third of Medicare spending. It will be important to determine how much of this burden is due to HF and how much to comorbid conditions. Development of specialized Medicare HF Management Programs, also providing comprehensive care for co-morbidities, could curtail these admissions and potentially reduce costs.

Abstract 15407: Comorbidities and the Associated Long-term Utilization of Transthoracic Echocardiography Among Medicare Beneficiaries at a Large Academic Center

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Patrick M Hyland ◽  
Jiaman Xu ◽  
Changyu Shen ◽  
Lawrence Markson ◽  
Warren J Manning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Transthoracic Echocardiography ◽  
Medicare Beneficiaries ◽  
Female Sex ◽  
History Of

Introduction: The association between baseline patient characteristics and the long-term utilization of transthoracic echocardiography (TTE) is unknown and may help focus value-based care initiatives. Methods: TTE reports from patients with ≥ 2 TTEs at our institution were linked to 100% Medicare Fee-for-service inpatient claims, 1/1/2000 – 12/31/2017. To avoid inclusion of individuals with short-interval follow-up, TTEs with < 1 year between studies were excluded. Validated claims algorithms were used to create 12 baseline cardiovascular comorbidities. Multivariable Poisson regression was used to estimate adjusted rates of TTE intensity according to baseline comorbidities. Results: Over a median (IQR) follow-up of 5.8 (3.1 – 9.5) years, 18,579 individuals (69.3 ± 12.8 years; 50.5% female) underwent a total of 59,759 TTEs (range 2 – 59). The median TTE intensity was 0.64 TTEs/patient/year (IQR 0.35 – 1.24; range 0.11 – 22.02). The top five contributors to TTE intensity were heart failure, chronic kidney disease, history of myocardial infarction, smoking, and hyperlipidemia ( Figure ). Female sex was associated with decreased TTE utilization (adjusted RR 0.95, 95% CI 0.94-0.96, p < 0.0001). Atrial fibrillation, hypertension, and history of ischemic stroke or transient ischemic attack were not significantly related to TTE intensity after multivariable adjustment (all p > 0.05). Conclusions: Among Medicare beneficiaries with ≥ 2 TTEs at our institution, the median TTE intensity was 0.64 TTEs/patient/year but varied widely. Heart failure, chronic kidney disease, and history of myocardial infarction were the strongest predictors of increased utilization. Female sex was associated with decreased utilization, reflecting broader disparities in utilization of cardiovascular procedures. Further research is needed to clarify reasons for this sex disparity and associations with cardiovascular outcomes.

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