JACC: Heart Failure
Medicare Expenditures by Race/Ethnicity After Hospitalization for Heart Failure With Preserved Ejection Fraction
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Author + information
- Boback Ziaeian, MD, PhDa,b,
- Paul A. Heidenreich, MD, MSc,
- Haolin Xu, MSd,
- Adam D. DeVore, MD, MHSd,e,
- Roland A. Matsouaka, PhDd,f,
- Adrian F. Hernandez, MD, MHSd,
- Deepak L. Bhatt, MD, MPHg,
- Clyde W. Yancy, MDh and
- Gregg C. Fonarow, MDi,∗ (gfonarow{at}mednet.ucla.edu)
- aDivision of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- bDivision of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- cDivision of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
- dDuke Clinical Research Institute, Durham, North Carolina
- eDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- fDepartment of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
- gHeart and Vascular Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- hDivision of Cardiology, Northwestern University, Chicago, Illinois
- iAhmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Avenue, Room A2-237 CHS, Los Angeles, California 90095-1679.
Graphical abstract
Abstract
Objectives The purpose of this study was to analyze cumulative Medicare expenditures at index admission and after discharge by race or ethnicity.
Background Heart failure with preserved ejection fraction (HFpEF) is a growing proportion of heart failure (HF) admissions. Research on health care expenditures for patients with HFpEF is limited.
Methods Records of patients discharged from the Get With The Guidelines-Heart Failure registry between 2006 and 2014 were linked to Medicare data. The primary outcome was unadjusted payments for acute care services. Comparisons between race/ethnic groups were made using generalized linear mixed models. Cost ratios were reported by race/ethnicity, and adjustments were made sequentially for patient characteristics, hospital factors, and regional socioeconomic status.
Results Median Medicare costs for index hospitalizations were $7,241 for the entire cohort, $7,049 for whites, $8,269 for blacks, $8,808 for Hispanics, $8,477 for Asians, and $8,963 for other races. Median costs at 30 days for readmitted patients were $9,803 and $17,456 for the entire cohort at 1-year. No significant differences were seen in index admission cost ratios by race/ethnicity. At 30 days among readmitted patients, costs were 9% higher (95% confidence interval [CI]: 1% to 17%; p = 0.020) for blacks in the fully adjusted model than whites. At 1 year, costs were 14% higher (95% CI: 9% to 18%; p < 0.001) for blacks, 7% higher (95% CI: 0% to 14%; p = 0.041) for Hispanics, and 24% higher (95% CI: 8% to 42%; p = 0.003) for patients of other races. No significant differences between white and Asian expenditures were noted.
Conclusions Minority patients with HFpEF have greater acute care service costs. Further research of improving care delivery is needed to reduce acute care use for vulnerable populations.
- BMI
- CMS
- diastolic heart failure
- health care costs
- health care disparities
- heart failure with preserved ejection fraction
- hospital readmissions
- hospitalization
Footnotes
Dr. Ziaeian was supported by the American College of Cardiology Presidential Career Developmental Award and American Heart Association 2015 Young Investigator Database Research Seed Grant. The Get With The Guidelines-Heart Failure program, provided by the American Heart Association, is sponsored in part by Amgen Cardiovascular and previously by Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Dr. DeVore has received research support from the American Heart Association, Amgen, and Novartis; and has consulted for Novartis. Dr. Hernandez has received research support from AstraZeneca, Bayer, Luitpold, GlaxoSmithKline, Merck, Novartis, Portola Pharmaceuticals, and Verily; and has received honoraria from Amgen, Bayer, Boehringer-Ingelheim, Boston Scientific, Myokardia, Novartis, and Sanofi. Dr. Bhatt is a member of the advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; sits on the Board of Directors of Boston VA Research Institute and Society of Cardiovascular Patient Care; is Chair of the American Heart Association Quality Oversight Committee; a member of the Data Monitoring Committees of Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; has received honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committee), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees), Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), and VA CART Research and Publications Committee (Chair); research funding from Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Eli Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); is site co-investigator for Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); a trustee of American College of Cardiology; and has performed unfunded research for FlowCo, Merck, PLx Pharma, and Takeda. Dr. Fonarow has received research support from U.S. National Institutes of Health; and has consulted for Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 20, 2017.
- Revision received December 11, 2017.
- Accepted December 14, 2017.
- 2018 American College of Cardiology Foundation
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