Epidemiology of Cardiac Amyloidosis–Associated Heart Failure Hospitalizations Among Fee-for-Service Medicare Beneficiaries in the United States

ABSTRACTImportanceAs the population of the United States (US) ages, there is considerable interest in ensuring safe and high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse.ObjectiveTo estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to demographic and geriatric characteristics.DesignProspective longitudinal study.SettingContinental US from 2011 to 2016.Participants5,571 community-living fee-for-service Medicare beneficiaries, aged 65+, from the National Health and Aging Trends Study (NHATS).Main Outcomes and MeasuresMajor surgeries were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the baseline NHATS assessment.ResultsThe nationally-representative incidence of major surgery per 100 person-years was 8.8 (95% confidence interval [CI], 8.2-9.5), with estimates of 5.2 (95% CI, 4.7-5.7) and 3.7 (95% CI, 3.3-4.1) for elective and non-elective surgeries. The adjusted incidence of major surgery peaked at 10.8 (95% CI, 9.4-12.4) in persons 75-79 years, increased from 6.6 (95% CI, 5.8-7.5) in the non-frail group to 10.3 (95% CI, 8.9-11.9) in the frail group, and was similar by sex (males 8.6 [95% CI, 7.7-9.6]; females 8.3 [95% CI, 7.5-9.1]) and dementia (no 8.6 [95% CI, 7.9-9.3]; possible 7.8 [95% CI, 6.3-9.6]; probable 8.1 [95% CI, 6.7-9.9]). The 5-year cumulative risk of major surgery was 13.8% (95% CI, 12.2%-15.5%), representing nearly 5 million unique older persons (4,958,048 [95% CI, 4,345,342-5,570,755]), including 12.1% (95% CI, 9.5%-14.6%) in persons 85-89 years, 9.1% (95% CI, 7.2%-11.0%) in those ≥90 years, 12.1% (95% CI, 9.9%-14.4%) in those with frailty, and 12.4% (95% CI, 9.8%-15.0%) in those with probable dementia.Conclusions and RelevanceMajor surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups such as the oldest old, those with frailty or dementia, and those undergoing non-elective surgery. The burden of major surgery in older Americans will add to the challenges ahead for the US health care system in our aging society.KEY POINTSQuestionWhat is the incidence and cumulative risk of major surgery in older persons in the United States?FindingsIn this prospective longitudinal study, data from 5,571 community-living fee-for-service Medicare beneficiaries were used to calculate nationally-representative estimates for the incidence and cumulative risk of major surgery over a 5-year period. Nearly 9 major surgeries were performed annually for every 100 older persons, and more than 1 in 7 Medicare beneficiaries underwent a major surgery over 5 years, representing nearly 5 million unique older persons.MeaningMajor surgery is a common event in the lives of community-living older persons.

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Abstract 236: Trends in Hospitalization for Digoxin Toxicity and Subsequent Outcomes Among Medicare Beneficiaries in the United States, 1999-2011

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.236 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Sudhakar V Nuti ◽

Frederick A Masoudi ◽

James V Freeman ◽

Karthik Murugiah ◽

Nihar R Desai ◽

...

Keyword(s):

United States ◽

Hospital Mortality ◽

The United States ◽

National Sample ◽

Digoxin Toxicity ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Annual Change ◽

Hospital Discharge Diagnosis ◽

Annual Decline

Objective: To characterize changes in rates of hospitalization for digoxin toxicity and trends in the associated mortality and readmission among older adults over a 12-year period in the United States. Methods: We studied 33,952,331 Medicare fee-for-service beneficiaries 65 years or older with a hospital discharge diagnosis of digoxin toxicity in the United States from 1999 to 2011. Outcome measures were rates of hospitalization for digoxin toxicity; in-hospital mortality; 30-day mortality; and 30-day readmission. Results: There were 20,957 hospitalizations for a principal or secondary diagnosis of digoxin toxicity between 1999 and 2011. The rate declined significantly from 15.2 per 100,000 person-years (95% confidence interval [CI]: 14.7-15.7) in 1999 to 2.1 per 100,000 person-years (95% CI: 1.9-2.3) in 2011 (p<0.001), representing an adjusted annual decline of 17.0% (95% CI: 16.2-17.0) (Figure 1). Between 1999 and 2011, the observed in-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity declined significantly, from 6.0% (95% CI: 5.2-6.8) to 3.3% (95% CI: 2.0-5.1) (p<0.01) and 14.0% (95% CI: 13.0-15.2) to 10.6% (95% CI: 8.2-13.4) (p<0.05), respectively, representing an annual decline for in-hospital mortality of 5.0% (95% CI: 3.7-7.2) and for 30-day mortality of 4.0% (95% CI: 3.1-5.7). The overall observed 30-day readmission rate declined significantly from 23.5% (95% CI: 22.1-24.9) in 1999 to 18.9% (95% CI: 15.6-22.3) in 2011 (p<0.05), but there was no significant decline in the adjusted annual change in 30-day readmission (1.0%, 95% CI: 0.0-1.7). Conclusions: In a national sample of Medicare beneficiaries, the rate of hospitalization for digoxin toxicity and subsequent mortality declined significantly between 1999 and 2011.

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Association of Socioeconomic Disadvantage With Mortality and Readmissions Among Older Adults Hospitalized for Pulmonary Embolism in the United States

Journal of the American Heart Association ◽

10.1161/jaha.121.021117 ◽

2021 ◽

Author(s):

Rishi K. Wadhera ◽

Eric A. Secemsky ◽

Yun Wang ◽

Robert W. Yeh ◽

Samuel Z. Goldhaber

Keyword(s):

United States ◽

Older Adults ◽

Pulmonary Embolism ◽

The United States ◽

Mortality Rates ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Socioeconomically Disadvantaged ◽

Vein Thrombosis ◽

Advanced Therapies

Background In the United States, hospitalizations for pulmonary embolism (PE) are increasing among older adults insured by Medicare. Although efforts to reduce health disparities have intensified, it remains unclear whether clinical outcomes differ between socioeconomically disadvantaged and nondisadvantaged Medicare beneficiaries hospitalized with PE. Methods and Results In this study, there were 53 386 Medicare fee‐for‐service beneficiaries age ≥65 years hospitalized for PE between October 2015 and January 2017. Of these, 5494 (10.3%) were socioeconomically disadvantaged and 47 892 (89.7%) were nondisadvantaged. Socioeconomically disadvantaged adults were of similar age as nondisadvantaged adults (77.1 versus 77.0), more likely to be female (68.5% versus 54.2%), and less likely to receive advanced therapies (11.0% versus 12.1%). After adjustment for demographics, 90‐day all‐cause mortality rates were similar between disadvantaged and nondisadvantaged adults. In contrast, 1‐year mortality rates were higher among socioeconomically disadvantaged adults (hazard ratio [HR], 1.16; 95% CI, 1.10–1.22), although these differences were partially attenuated after additional adjustments for comorbidities and PE severity (HR, 1.09; 95% CI, 1.02–1.16). Risk‐adjusted 30‐day and 90‐day all‐cause readmission rates were substantially higher among socioeconomically disadvantaged patients (30‐day HR, 1.14 [95% CI, 1.06–1.22]; 90‐day HR, 1.18 [95% CI, 1.12–1.25]). In addition, 90‐day readmissions attributed to PE, deep vein thrombosis, and/or bleeding were higher among socioeconomically disadvantaged patients (HR, 1.16; 95% CI, 1.02–1.32). Conclusions Socioeconomically disadvantaged older adults hospitalized with PE have higher 1‐year mortality rates compared with their nondisadvantaged counterparts. Nearly 1 in 3 socioeconomically disadvantaged older adults was readmitted within 90 days of a hospitalization for PE. Targeted strategies are needed to improve transitional and ambulatory care for this vulnerable population.

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Geographic and Demographic Variability in Transcatheter Aortic Valve Replacement Dispersion in the United States

Journal of the American Heart Association ◽

10.1161/jaha.120.019588 ◽

2021 ◽

Author(s):

Michael N. Young ◽

Stephen Kearing ◽

David Malenka ◽

Philip P. Goodney ◽

Jonathan Skinner ◽

...

Keyword(s):

United States ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

The United States ◽

Disruptive Technology ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Transcatheter Aortic Valve

Background Transcatheter aortic valve replacement (TAVR) has transformed the management of aortic valve stenosis. However, little national data are available characterizing the geographic and demographic dispersion of this disruptive technology relative to surgical aortic valve replacement (SAVR). Methods and Results In this US claims‐based study, we analyzed a 100% sample of fee‐for‐service Medicare beneficiaries from 2012 to 2017 and examined national rates of TAVR versus SAVR. Procedure rates were compared across years as a function of age, sex, race, and geography for TAVR and SAVR beneficiaries. There was significant growth in TAVR from 15.4 beneficiaries/100 000 enrollees in 2012 to 90.6 in 2017 ( P <0.001). SAVR rates declined from 92.8 beneficiaries/100 000 enrollees in 2012 to 63.5 in 2017 ( P <0.001). The growth of TAVR varied as a function of age ( P <0.0001). While TAVR was the dominant strategy among beneficiaries ≥85 and 75 to 84 years old, SAVR was more common among beneficiaries 65 to 74 years old. TAVR was also used more frequently than SAVR among women ( P <0.001). While TAVR increased among all races, it was less commonly used among non‐White beneficiaries ( P <0.001). Contemporary use of TAVR relative to SAVR varied significantly by geographic location, with a TAVR:SAVR ratio in 2017 of 1.24 in the Midwest and 1.68 in the Northeast ( P <0.001). Conclusions In 2017, the number of Medicare beneficiaries receiving TAVR exceeded SAVR for the first time in the United States. There is significant variation, however, in the geographic expansion of TAVR and in patient demographics relative to SAVR.

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Stroke Hospitalizations Before and During COVID-19 Pandemic Among Medicare Beneficiaries in the United States

Stroke ◽

10.1161/strokeaha.121.034562 ◽

2021 ◽

Author(s):

Quanhe Yang ◽

Xin Tong ◽

Sallyann Coleman King ◽

Benjamin S. Olivari ◽

Robert K. Merritt

Keyword(s):

United States ◽

Patient Characteristics ◽

The United States ◽

Emergency Department Visits ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Percent Reduction ◽

Stroke Patients ◽

Race Ethnicity ◽

National Emergency

Background and Purpose: Emergency department visits and hospitalizations for stroke declined significantly following declaration of coronavirus disease 2019 (COVID-19) as a national emergency on March 13, 2020, in the United States. This study examined trends in hospitalizations for stroke among Medicare fee-for-service beneficiaries aged ≥65 years and compared characteristics of stroke patients during COVID-19 pandemic to comparable weeks in the preceding year (2019). Methods: For trend analysis, we examined stroke hospitalizations from week 1 in 2019 through week 44 in 2020. For comparison of patient characteristics, we estimated percent reduction in weekly stroke hospitalizations from 2019 to 2020 during weeks 10 through 23 and during weeks 24 through 44 by age, sex, race/ethnicity, and state. Results: Compared to weekly numbers of hospitalizations for stroke reported during 2019, stroke hospitalizations in 2020 decreased sharply during weeks 10 through 15 (March 1–April 11), began increasing during weeks 16 through 23, and remained at a level lower than the same weeks in 2019 from weeks 24 through 44 (June 7–October 31). During weeks 10 through 23, stroke hospitalizations decreased by 22.3% (95% CI, 21.4%–23.1%) in 2020 compared with same period in 2019; during weeks 24 through 44, they decreased by 12.1% (95% CI, 11.2%–12.9%). The magnitude of reduction increased with age but similar between men and women and among different race/ethnicity groups. Reductions in stroke hospitalizations between weeks 10 through 23 varied by state ranging from 0.0% (95% CI, −16.0%–1.7%) in New Hampshire to 36.2% (95% CI, 24.8%–46.7%) in Montana. Conclusions: One-in-5 fewer stroke hospitalizations among Medicare fee-for-service beneficiaries occurred during initial weeks of the COVID-19 pandemic (March 1–June 6) and weekly stroke hospitalizations remained at a lower than expected level from June 7 to October 31 in 2020 compared with 2019. Changes in stroke hospitalizations varied substantially by state.

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