Ambulatory Health Care Service Use and Costs Among Commercially Insured US Adults With Congenital Heart Disease

Agarwal, Anushree; Vittinghoff, Eric; Myers, Janet J.; Dudley, R. Adams; Khan, Abigail; John, Anitha S.; Marcus, Gregory M.

doi:10.1001/jamanetworkopen.2020.18752

Cited by 10 publications

(10 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…108 Among adults with commercially purchased insurance, those with CCDs had more health care visits and higher expenditures than those without CCD, even when controlling for baseline characteristics and comorbidities. 109 …”

Section: Congenital Cardiovascular Defects and Kawasaki Diseasementioning

confidence: 99%

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2022

Circulation

3,830

2,336

View full text Add to dashboard Cite

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Methods: The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year’s edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. Results: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. Conclusions: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

show abstract

Section: Congenital Cardiovascular Defects and Kawasaki Diseasementioning

confidence: 99%

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2022

Circulation

3,830

2,336

View full text Add to dashboard Cite

show abstract

“…Among adults with commercially purchased insurance, those with CCDs had more health care visits and higher expenditures than those without CCDs, even when controlling for baseline characteristics and comorbidities. 112…”

Section: Congenital Cardiovascular Defects and Kawasaki Diseasementioning

confidence: 99%

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2023

Circulation

3,590

702

View full text Add to dashboard Cite

BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year’s worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

show abstract

“…For patients with codes for >1 CHD diagnosis, we used the hierarchical algorithm proposed by Broberg et al 22 to designate 1 condition per patient as the principal CHD diagnosis. As described earlier, 13 , 22 , 23 , 24 we excluded ICD‐9 codes that have lower specificity for CHD, including atrial septal defect, bicuspid aortic valve, aortic stenosis, congenital mitral valve disease, anomalous coronary arteries, and unspecified congenital anomalies. The remaining patients with CHD were categorized using the American Heart Association/American College of Cardiology anatomic classification 25 as (1) complex CHD, defined by the presence of Eisenmenger (for those with a concomitant CHD diagnosis code and pulmonary arterial hypertension), univentricular heart defects (including hypoplastic left heart syndrome), transposition of the great arteries, tetralogy of Fallot, truncus arteriosus, and endocardial cushion defects; (2) moderately complex CHD, defined by the presence of Ebstein anomaly, coarctation of aorta, anomalies of the pulmonary artery, anomalies of the pulmonary valve, anomalies of the tricuspid valve, unspecified septal defects, anomalies of the great vein, subaortic stenosis, and aortic anomalies; and (3) simple CHD, defined by the presence of ventricular septal defect and patent ductus arteriosus.…”

Section: Methodsmentioning

confidence: 99%

“… 9 , 12 Understanding the impact of insurance on these services is particularly important for adults with chronic childhood preexisting conditions like congenital heart disease (CHD), a vulnerable high‐cost population. 13 , 14 , 15 Knowledge about this can add evidence to inform national conversations about important policies such as Medicaid expansion and tangible influences of preventing or allowing denial of insurance for patients with preexisting conditions.…”

mentioning

confidence: 99%

Association of Insurance Status With Emergent Versus Nonemergent Hospital Encounters Among Adults With Congenital Heart Disease

Agarwal

Gurvitz

Myers

et al. 2021

JAHA

Self Cite

View full text Add to dashboard Cite

Background Although the number of hospital visits has exponentially increased for adults with congenital heart disease (CHD) over the past few decades, the relationship between insurance status and hospital encounter type remains unknown. The purpose of this study was to evaluate the association between insurance status and emergent versus nonemergent encounters among adults with CHD ≥18 years old. Methods and Results We used California Office of Statewide Health Planning and Development Database from January 2005 to December 2015 to determine the trends of insurance status and encounters and the association of insurance status on encounter type among adults with CHD. A total 58 359 nonpregnancy encounters were identified in 6077 patients with CHD. From 2005 to 2015, the number of uninsured encounters decreased by 38%, whereas government insured encounters increased by 124% and private by 79%. Overall, there was a significantly higher proportion of emergent than nonemergent encounters associated with uninsured status (13.0% versus 1.8%; P <0.0001), whereas the proportion of nonemergent encounters associated with private insurance was higher than emergent encounters (35.8% versus 62.4%; P <0.0001). When individual patients with CHD became uninsured, they were ≈5 times more likely to experience an emergent encounter ( P <0.0001); upon changing from uninsured to insured, they were significantly less likely to have an emergent encounter ( P <0.001). After multivariate adjustment, uninsured status exhibited the highest odds of an emergent rather than nonemergent encounter compared with all other covariates (adjusted odds ratio, 9.20; 95% CI, 7.83–10.8; P <0.0001). Conclusions Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of patients with CHD might result in meaningful reductions in emergent encounters and a more efficient use of resources.

show abstract

Ambulatory Health Care Service Use and Costs Among Commercially Insured US Adults With Congenital Heart Disease

Abstract: Author Contributions: Drs Agarwal and Vittinghoff had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 10 publications

References 6 publications

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Association of Insurance Status With Emergent Versus Nonemergent Hospital Encounters Among Adults With Congenital Heart Disease

Contact Info

Product

Resources

About