Javier Valero-Elizondo1, Joseph A Salami1, Oluseye Ogunmoroti1, Chukwuemeka U Osondu1, Ehimen C Aneni1, Rehan Malik1, Erica S Spatz1, Jamal S Rana1, Salim S Virani1, Ron Blankstein1, Michael J Blaha1, Emir Veledar1, Khurram Nasir2. 1. From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.). 2. From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.); Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT (E.S.S.); Divisions of Cardiology (J.S.R.) and Research (J.S.R.), Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco (J.S.R.); Section of Cardiovascular Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (S.S.V.); Non-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B., K.N.); and Department of Medicine, School of Medicine, Emory University, Atlanta, GA (E.V.). KhurramN@baptisthealth.net.
Abstract
BACKGROUND: The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD). METHODS AND RESULTS: The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD. CONCLUSIONS: Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD.
BACKGROUND: The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD). METHODS AND RESULTS: The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD. CONCLUSIONS: Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD.
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: David I Feldman; Javier Valero-Elizondo; Joseph A Salami; Jamal S Rana; Oluseye Ogunmoroti; Victor Okunrintemi; Chukwuemeka U Osondu; Erica S Spatz; Salim S Virani; Ron Blankstein; Michael J Blaha; Emir Veledar; Khurram Nasir Journal: Cardiovasc Endocrinol Metab Date: 2018-08-15
Authors: Victor Okunrintemi; Rohan Khera; Erica S Spatz; Joseph A Salami; Javier Valero-Elizondo; Haider J Warraich; Salim S Virani; Ron Blankstein; Michael J Blaha; Timothy M Pawlik; Kumar Dharmarajan; Harlan M Krumholz; Khurram Nasir Journal: J Gen Intern Med Date: 2019-02-19 Impact factor: 5.128
Authors: Cuiping Schiman; Lei Liu; Ya-Chen Tina Shih; Lihui Zhao; Martha L Daviglus; Kiang Liu; James Fries; Daniel B Garside; Thanh-Huyen T Vu; Jeremiah Stamler; Donald M Lloyd-Jones; Norrina B Allen Journal: Prev Med Date: 2018-12-28 Impact factor: 4.018
Authors: Elizabeth B Kirkland; Marc Heincelman; Kinfe G Bishu; Samuel O Schumann; Andrew Schreiner; R Neal Axon; Patrick D Mauldin; William P Moran Journal: J Am Heart Assoc Date: 2018-05-30 Impact factor: 5.501
Authors: Kristal J Aaron; Lisandro D Colantonio; Luqin Deng; Suzanne E Judd; Julie L Locher; Monika M Safford; Mary Cushman; Meredith L Kilgore; David J Becker; Paul Muntner Journal: J Am Heart Assoc Date: 2017-02-01 Impact factor: 5.501