The healthcare burden of disease progression in medicare patients with functional mitral regurgitation |
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Authors: | Peter A. McCullough Hirsch S. Mehta David P. Cork Colin M. Barker Candace Gunnarsson Sarah Mollenkopf |
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Affiliation: | 1. Baylor Heart and Vascular Hospital, Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA;2. SHARP Memorial Hospital, San Diego Cardiac Center, San Diego, CA, USA;3. Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA;4. Consultancy, Gunnarsson Consulting, Jupiter, FL, USA;5. GHER, Edwards Lifesciences, Irvine, CA, USA |
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Abstract: | AbstractObjective: This retrospective database analysis estimated the incremental effect that disease progression from non-clinically significant functional mitral regurgitation (nsFMR) to clinically significant FMR (sFMR) has on clinical outcomes and costs.Methods: Medicare Fee for Service beneficiaries with nsFMR were examined, defined as those with a heart failure diagnosis prior to MR. Patients were classified as ischemic if there was a history of: CAD, AMI, PCI, or CABG. The primary outcome was time to sFMR, defined as pulmonary hypertension, atrial fibrillation, mitral valve surgery, serial echocardiography, or death, using a Cox hazard regression model. Annualized hospitalizations, inpatient hospital days, and healthcare expenditures were also modeled.Results: Patients with IHD had higher risk (Hazard Ratio?=?1.22 [1.14–1.30]) for disease progression compared to patients without. The progression cohort had significantly more annual inpatient hospitalizations (non-IHD?=?1.32; IHD?=?1.40) than the non-progression cohort (non-IHD?=?0.36; IHD?=?0.34), and significantly more annual inpatient hospital days (non-IHD?=?13.07; IHD?=?13.52) than the non-progression cohort (non-IHD?=?2.29; with IHD?=?2.08). The progression cohort had over 3.5-times higher costs vs the non-progression cohort, independent of IHD (non-IHD?=?$12,798 vs $46,784; IHD?=?$12,582 vs $49,348).Conclusion: Treating FMR patients earlier in their clinical trajectory may prevent disease progression and reduce high rates of healthcare utilization and expenditures. |
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Keywords: | Functional mitral valve regurgitation disease progression healthcare utilization healthcare expenditure |
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