Association Between Medicare Expenditure Growth and Mortality Rates in Patients With Acute Myocardial Infarction

Likosky, Donald S.; Parys, Jessica Van; Zhou, Weiping; Borden, William B.; Weinstein, Milton C.; Skinner, Jonathan

doi:10.1001/jamacardio.2017.4771

Cited by 28 publications

(25 citation statements)

References 37 publications

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“…A trend of increase in ED visits was observed throughout the years, consistent with previous reports [20]. This disparity in the trends of ED utilization and the other resources could possibly be attributed to increased awareness and caution by the AMI survivors and their healthcare providers to complaints that could be related to an acute cardiac condition.…”

Section: Discussionsupporting

confidence: 88%

“…Importantly, our analysis includes all hospitalizations rather than those for a particular cause, while previous reports showed that about 30% of readmissions are for reasons unrelated to the original condition [19]. In partial consistency with our findings, a recent report from the US found significant differences across the country and between different Table 1 The baseline characteristics of the study population by study year (Continued ) Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 p for trend n 426 1233 1822 2491 3111 3695 4211 4664 5067 5482 5650 5223 services, in ambulatory and outpatient resource utilization and expenditure following hospital discharge with an AMI (31-180 days) between 1999 and 2014 [20]. The current study was not designed to determine the causes for the observed time dependent changes.…”

Section: Discussionmentioning

confidence: 99%

“…The differences can stem from different study periods, adjustment to confounders as well as differences in healthcare systems. A recent report that evaluated expenditure on Medicare beneficiaries 180 days following AMI in four time periods 1999-2000, 2004, 2008 and 2013-2014) found that expenditure increased 13.9% from 1999 to 2000, and 2013,-2014, but declined 0.5% between 2008 and 2013-2014 [20]. It should however be mentioned that excluding patients that died throughout the first year might have resulted in underestimation of costs since treating these patients is usually associated with increased expenditure [16].…”

Section: Discussionmentioning

confidence: 99%

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Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

Shiyovich

Gilutz

Arbelle

et al. 2020

Isr J Health Policy Res

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Background: Acute myocardial infarction (AMI) is associated with greater utilization of healthcare resources and financial expenditure. Objectives: To evaluate temporal trends in healthcare resource utilization and costs following AMI throughout 2003-2015.Methods: AMI patients who survived the first year following hospitalization in a tertiary medical center (Soroka University Medical Center) throughout 2002-2012 were included and followed until 2015. Length of the in-hospital stay (LOS), emergency department (ED), primary care, outpatient consulting clinic visits and other ambulatory services, and their costs, were evaluated and compared annually over time.Results: Overall 8047 patients qualified for the current study; mean age 65.0 (SD = 13.6) years, 30.3% women. During follow-up, LOS and the number of primary care visits has decreased significantly. However, ED and consultant visits as well as ambulatory-services utilization has increased. Total costs have decreased throughout this period. Multivariate analysis, adjusted for potential confounders, showed as significant trend of decrease in LOS and ambulatory-services utilization, yet an increase in ED visits with no change in total costs.Conclusions: Despite a decline in utilization of most healthcare services throughout the investigated decade, healthcare expenditure has not changed. Further evaluation of the cost-effectiveness of long-term resource allocation following AMI is warranted. Nevertheless, we believe more intense ambulatory follow-up focusing on secondary prevention and early detection, as well as high-quality outpatient chest pain unit are warranted.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

Shiyovich

Gilutz

Arbelle

et al. 2020

Isr J Health Policy Res

View full text Add to dashboard Cite

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“…Our study was not able to determine the time to reperfusion, as the hours and minutes of admission and treatments were not available. A study involving the US Medicare found that a decreased 180-day mortality was associated with an early PCI, which was defined as the PCI performed at the first day of the index hospitalization [28]. In our study, the median stay of 3 days for patients undergoing PCI during the first hospitalization indicated that most PCIs were performed without a lengthy delay.…”

Section: Strengths and Limitationsmentioning

confidence: 49%

Access to reperfusion therapy and mortality outcomes in patients with ST-segment elevation myocardial infarction under universal health coverage in Thailand

Limwattananon

Jaratpatthararoj

Thungthong

et al. 2020

BMC Cardiovasc Disord

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Background: Evidence on access to reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI) and associated mortality in developing countries is scarce. This study determined time trends in the nationally aggregated reperfusion and mortality, examined distribution of percutaneous coronary intervention (PCI) utilization across provinces, and assessed the reperfusion-mortality association in Thailand that achieved universal health coverage in 2002.Methods: Data on hospitalization with STEMI in 2011-2017 of 69,031 Universal Coverage Scheme (UCS) beneficiaries were used for estimating changes in the national aggregates of % reperfusion and mortality by a timeseries analysis. Geographic distribution of PCI-capable hospitals and PCI recipients was illustrated per provinces. The reperfusion-mortality association was determined using the propensity-score matching of individual patients and panel data analysis at the hospital level. The exposure is a presence of PCI or thrombolysis. Outcomes are all-cause mortality within 30 and 180 days after an index hospitalization.Results: In 2011-2017, the PCI recipients increased annually 5.7 percentage (%) points and thrombolysis-only recipients decreased 2.2% points. The 30-day and 180-day mortalities respectively decreased annually 0.20 and 0.27% points among the PCI recipients, and they increased 0.79 and 0.59% points among the patients receiving no reperfusion over the same period. Outside Bangkok, the provinces with more than half of the patients receiving PCI increased from 4 provinces of PCI-capable hospitals in 2011 to 37 provinces, which included the neighboring provinces of the PCI-capable hospitals in 2017. Patients undergoing reperfusion had lower 30-day and 180-day mortalities respectively by 19.6 and 21.1% points for PCI, and by 14.1 and 15.1% points for thrombolysis only as compared with no reperfusion. The use of PCI was associated with decreases in 30-day and 180-day mortalities similarly by 5.4-5.5% points as compared with thrombolysis only. A hospital with 1% higher in the recipients of PCI had lower mortalities within 30 and 180 days by approximately 0.21 and 0.20%, respectively. Conclusions:Patients with STEMI in Thailand experienced increasing PCI access and the use of PCI was associated with lower mortality compared with thrombolysis only. This is an evidence of progress toward a universal coverage of high-cost and effective health care.

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“…AKI, acute kidney injury; IV, inverse variance; df, degrees of freedom. stent technology, a significantly larger number of patients are undergoing coronary catheterization (30). Concurrently, there is a growing need to limit post-procedural complications and enhance clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of acute kidney injury with radial vs. femoral access for patients undergoing coronary catheterization: An updated meta‑analysis of 46,816 patients

Wang

Chen

et al. 2020

Exp Ther Med

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Trans-radial access for percutaneous coronary intervention or angiography has gained popularity amongst interventional cardiologists. Radial access is also thought to reduce the incidence of acute kidney injury (AKI) in the immediate post-operative period. The purpose of the present study was to perform a comprehensive updated systematic review and meta-analysis comparing the incidence of AKI following the radial vs. femoral route of coronary catheterization. An electronic literature search of the PubMed, BioMed Central, Scopus, Cochrane Central Register of Controlled Trials and Google Scholar databases up to 1st January 2020 was performed. A total of 14 studies were included, 2 of which were randomized controlled trials (RCTs), and 6 studies utilized propensity score matching. Comparison of the data of 21,479 patients in the radial group and 25,337 patients in the femoral group indicated a reduced incidence of AKI with the radial route [odds ratio (OR):0.66, 95% CI: 0.54-0.81, P<0.0001, I 2 =74%]. Similar results were obtained with subgroup analyses for RCTs (OR: 0.87, 95% CI: 0.77-0.98, P=0.02, I 2 =0%), retrospective studies (OR: 0.57, 95% CI: 0.36-0.90, P=0.02, I 2 =86%) and propensity score-matched studies (OR: 0.63, 95% CI: 0.48-0.83, P=0.0009, I 2 =45%). Multivariable-adjusted ORs of AKI for the radial vs. femoral route were extracted from non-RCTs and pooled for a meta-analysis, which also demonstrated similar results (OR: 0.70, 95% CI: 0.57-0.88, P=0.002, I 2 =70%). Within the limitations of the study, the present results indicate that, as compared to femoral access, the use of trans-radial access for coronary catheterization is associated with a significantly reduced incidence of AKI. A reduction of AKI by ~34% may be expected with the use of radial access.

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Association Between Medicare Expenditure Growth and Mortality Rates in Patients With Acute Myocardial Infarction

Cited by 28 publications

References 37 publications

Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

Access to reperfusion therapy and mortality outcomes in patients with ST-segment elevation myocardial infarction under universal health coverage in Thailand

Comparison of acute kidney injury with radial vs. femoral access for patients undergoing coronary catheterization: An updated meta‑analysis of 46,816 patients

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Association Between Medicare Expenditure Growth and Mortality Rates in Patients With Acute Myocardial Infarction

Cited by 28 publications

References 37 publications

Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

Access to reperfusion therapy and mortality outcomes in patients with ST-segment elevation myocardial infarction under universal health coverage in Thailand

Comparison of acute kidney injury with radial vs. femoral access for patients undergoing coronary catheterization: An updated meta‑analysis of 46,816&nbsp;patients

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Comparison of acute kidney injury with radial vs. femoral access for patients undergoing coronary catheterization: An updated meta‑analysis of 46,816 patients