Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings

• Published in: Circulation. Heart failure Vol. 10; no. 11
• Main Authors: Khera, Rohan, Pandey, Ambarish, Ayers, Colby R, Agusala, Vijay, Pruitt, Sandi L, Halm, Ethan A, Drazner, Mark H, Das, Sandeep R, de Lemos, James A, Berry, Jarett D
• Format: Journal Article
• Language: English
• Published: United States 01-11-2017
• Subjects: Administrative Claims, Healthcare; Aged; Aged, 80 and over; Ambulatory Care - economics; Cardiology Service, Hospital - economics; Databases, Factual; Fee-for-Service Plans - economics; Female; Health Services Needs and Demand; Heart Failure - diagnosis; Heart Failure - economics; Heart Failure - epidemiology; Heart Failure - mortality; Humans; Incidence; Insurance Benefits - economics; Male; Medicare - economics; Needs Assessment; Prevalence; Prognosis; Time Factors; United States; heart failure; health policy; Medicare; hospitalization; incidence
• ISSN: 1941-3289; 1941-3297
• DOI: 10.1161/circheartfailure.117.004402

To assess the current landscape of the heart failure (HF) epidemic and provide targets for future health policy interventions in Medicare, a contemporary appraisal of its epidemiology across inpatient and outpatient care settings is needed.
In a national 5% sample of Medicare beneficiaries from 2002 to 2013, we identified a cohort of 2 331 939 unique fee-for-service Medicare beneficiaries ≥65-years-old followed for all inpatient and outpatient encounters over a 10-year period (2004-2013). Preexisting HF was defined by any HF encounter during the first year, and incident HF with either 1 inpatient or 2 outpatient HF encounters. Mean age of the cohort was 72 years; 57% were women, and 86% and 8% were white and black, respectively. Within this cohort, 518 223 patients had preexisting HF, and 349 826 had a new diagnosis of HF during the study period. During 2004 to 2013, the rates of incident HF declined 32%, from 38.7 per 1000 (2004) to 26.2 per 1000 beneficiaries (2013). In contrast, prevalent (preexisting + incident) HF increased during our study period from 162 per 1000 (2004) to 172 per 1000 beneficiaries (2013) (
<0.001 for both). Finally, the overall 1-year mortality among patients with incident HF is high (24.7%) with a 0.4% absolute decline annually during the study period, with a more pronounced decrease among those diagnosed in an inpatient versus outpatient setting (
<0.001) CONCLUSIONS: In recent years, there have been substantial changes in the epidemiology of HF in Medicare beneficiaries, with a decline in incident HF and a decrease in 1-year HF mortality, whereas the overall burden of HF continues to increase.