Heart failure
Predicting Costs Among Medicare Beneficiaries With Heart Failure

https://doi.org/10.1016/j.amjcard.2011.10.031Get rights and content

Disease management programs that target patients with the highest risk of subsequent costs may help payers and providers control health care costs, but identifying these patients prospectively is challenging. We hypothesized that medical history and clinical data from a heart failure registry could be used to prospectively identify patients with heart failure most likely to incur high costs. We linked Medicare inpatient claims to clinical registry data for patients with heart failure and calculated total Medicare costs during the year after the index heart failure hospitalization. We defined patients as having high costs if they were in the upper 5% (>$76,500) of the distribution. We used logistic regression models to identify patient and clinical characteristics associated with high costs. Costs for 40,317 patients in the study varied widely. Patients in the upper 5% of the cost distribution incurred mean costs of $117,193 ± 55,550 during 1 year of follow-up compared to $17,086 ± 17,792 for the lower-cost group. Demographic and clinical characteristics associated with high costs included younger age and black race; history of anemia, chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus, or peripheral vascular disease; serum creatinine level; and systolic blood pressure at admission. Mean 1-year Medicare costs for patients whom the model predicted would exceed the high-cost threshold were >2 times the costs for patients below the threshold. In conclusion, a model based on variables from clinical registries can identify a group of patients with heart failure who on average will incur higher costs in the first year after hospitalization.

Section snippets

Methods

We linked Medicare inpatient claims data from January 1, 2003, through December 31, 2006, with data from the OPTIMIZE-HF and GWTG-HF registries (http://www.Clinicaltrials.gov, trial identifier NCT00344513). In 2005 OPTIMIZE-HF transitioned to GWTG-HF under sponsorship of the American Heart Association. The registries had the same design, inclusion criteria, and data-collection methods.5, 6 Outcome Sciences, Inc. (Cambridge, Massachusetts), serves as the data-collection and coordination center

Results

After linking hospitalizations from OPTIMIZE-HF and GWTG-HF to Medicare inpatient claims and applying the exclusion criteria, the study population included 40,317 index cases (Table 1). Ischemic heart disease, diabetes, and hypertension were the most common comorbid conditions. The 75% derivation cohort and the 25% validation cohort were comparable to the full cohort in patient characteristics (data not shown).

As presented in Table 2, unadjusted 1-year mortality was 34.4% and 1-year readmission

Discussion

We used clinical registry data to derive and validate a method for prospectively identifying patients with heart failure who are most likely to incur high costs in the year after a heart failure hospitalization. Although prospective identification of these patients is challenging, it is possible to create a model with adequate discrimination and calibration using data readily available from an inpatient episode of heart failure.

The approach taken to allow prospective identification of patients

Acknowledgment

Damon M. Seils, MA, Duke University, provided editorial assistance and prepared the report. Mr. Seils did not receive compensation for his assistance apart from his employment at the institution where the study was conducted.

References (28)

  • Specifications manual for national hospital quality measures

  • L.H. Curtis et al.

    Representativeness of a national heart failure quality-of-care registry: comparison of OPTIMIZE-HF and non–OPTIMIZE-HF Medicare patients

    Circ Cardiovasc Qual Outcomes

    (2009)
  • D.J. Whellan et al.

    Costs of inpatient care among Medicare beneficiaries with heart failure, 2001 to 2004

    Circ Cardiovasc Qual Outcomes

    (2010)
  • L.H. Curtis et al.

    Early and long-term outcomes of heart failure in elderly persons, 2001–2005

    Arch Intern Med

    (2008)
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    Get With the Guidelines-Heart Failure (GWTG-HF) is a program of the American Heart Association, Dallas, Texas, and is supported by Medtronic, Minneapolis, Minnesota; Ortho-McNeil, Raritan, New Jersey; and the American Heart Association Pharmaceutical Roundtable. GWTG-HF has been funded previously by support from GlaxoSmithKline, Brentford, Middlesex, United Kingdom. The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) was funded by GlaxoSmithKline. This study was supported by Grant 087512N from the American Heart Association Pharmaceutical Roundtable Outcomes Center, Grant U18HS10548 from the Agency for Healthcare Research and Quality, Rockville, Maryland, Grant R01AG026038 from the National Institute on Aging, Bethesda, Maryland, and grant U01HL066461 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Dr. Hernandez received Grant 0675060N from the American Heart Association Pharmaceutical Roundtable. Dr. Fonarow is supported by the Ahmanson Foundation, Beverly Hills, California, and the Corday Family Foundation, Beverly Hills, California.

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