Background:
Public health campaigns aimed at reducing the morbidity, mortality and economic burden of atherosclerotic cardiovascular disease (ASCVD) have mainly targeted coronary artery disease (CAD). Stroke and peripheral artery disease (PAD) are associated with substantial medical and financial burden for patients and the US healthcare system.
Objective:
We sought to compare the associations of patient-reported outcomes, resource utilization, and healthcare expenditures across the 3 major ASCVD types (CAD, stroke, or PAD).
Methods:
We used data from the Medical Expenditure Panel Survey (MEPS) conducted between 2006-2015 and included adults aged ≥18 yrs. MEPS is a nationally representative US sample and provides information on patient-reported outcomes (PROs), medical conditions, healthcare utilization and expenditures. The ASCVD types were ascertained by ICD-9 codes and/or self-reported data. Participants with more than 1 ASCVD type were not included. The associations of PROs and health utilization were quantified and contrasted across the 3 ASCVD types using multivariable adjusted regression models. A 2-part econometric model was used to assess healthcare expenditures.
Results:
The study sample included 14,262 MEPS participants with 1 type of ASCVD, translating into 15.9 million US adults. The mean age (SD) was 65 (±14) yrs; 48% were women, 59.6% had the diagnosis of CAD only, 37.5% stroke only, and 2.9% PAD only. Participants with stroke were more likely to report poor patient-provider communication [OR 1.37 (95% CI 1.18-1.59)], poor healthcare satisfaction, and more ED visits, and were less likely to be on a statin and aspirin, compared to CAD (
Table
). Participants with PAD also had higher odds of not being on aspirin [3.10 (2.31-4.16)] and statin [2.01 (1.37-2.95)], compared to CAD. PAD was associated with the highest annual total and out-of-pocket expenditures among the 3 ASCVDs.
Conclusion:
Both stroke and PAD were associated with low uptake of guideline-directed preventive therapies, compared to CAD, with PAD having the highest healthcare expenditures among the 3 ASCVD types. Our results highlight a missed opportunity for secondary ASCVD prevention among patients with PAD and stroke, and the need for public health campaigns to direct equal attention to all 3 major ASCVDs.
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