Jonathan Myers1, Rachelle Doom2, Robert King2, Holly Fonda2, Khin Chan2, Peter Kokkinos3, David H Rehkopf4. 1. Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Division of Cardiovascular Medicine, Stanford University, Stanford, CA. Electronic address: drj993@aol.com. 2. Veterans Affairs Palo Alto Health Care System, Palo Alto, CA. 3. Veterans Affairs Medical Center, Washington, DC. 4. Division of Clinical Medicine & Population Health, Stanford University, Stanford, CA.
Abstract
OBJECTIVE: To determine the association between cardiorespiratory fitness (CRF) and annual health care costs in Veterans. PATIENTS AND METHODS: The sample included 9942 subjects (mean age, 59±11 years) undergoing a maximal exercise test for clinical reasons between January 2005 and December 2012. Cardiorespiratory fitness, expressed as a percentage of age-predicted peak metabolic equivalents (METs) achieved, was categorized in quartiles. Total and annualized health care costs, derived from the Veterans Administration Allocated Resource Center, were compared using multiple regression, controlling for demographic and clinical characteristics. RESULTS: A gradient for reduced health care costs was observed as CRF increased, with subjects in the least-fit quartile having approximately $14,662 (P<.001) higher overall costs per patient per year compared with those in the fittest quartile, after controlling for potential confounding variables. Each 1-MET higher increment in fitness was associated with a $1592 annual reduction in health care costs (5.6% lower cost per MET), and each higher quartile of fitness was associated with a $4163 annual cost reduction per patient. The effect of CRF was more pronounced among subjects without cardiovascular disease (CVD), suggesting that the results were not driven by the possibility that less-fit individuals had greater CVD. Cost savings attributable to higher fitness were greatest in overweight and obese subjects, with lower savings observed among those individuals with a body mass index less than 25 kg/m2. In a model including historical, clinical, and exercise test responses, heart failure was the strongest predictor of health care costs, followed by CRF (P<.01). CONCLUSION: Low CRF is associated with higher health care costs. Efforts to improve CRF may not only improve health but also result in lower health care costs. Published by Elsevier Inc.
OBJECTIVE: To determine the association between cardiorespiratory fitness (CRF) and annual health care costs in Veterans. PATIENTS AND METHODS: The sample included 9942 subjects (mean age, 59±11 years) undergoing a maximal exercise test for clinical reasons between January 2005 and December 2012. Cardiorespiratory fitness, expressed as a percentage of age-predicted peak metabolic equivalents (METs) achieved, was categorized in quartiles. Total and annualized health care costs, derived from the Veterans Administration Allocated Resource Center, were compared using multiple regression, controlling for demographic and clinical characteristics. RESULTS: A gradient for reduced health care costs was observed as CRF increased, with subjects in the least-fit quartile having approximately $14,662 (P<.001) higher overall costs per patient per year compared with those in the fittest quartile, after controlling for potential confounding variables. Each 1-MET higher increment in fitness was associated with a $1592 annual reduction in health care costs (5.6% lower cost per MET), and each higher quartile of fitness was associated with a $4163 annual cost reduction per patient. The effect of CRF was more pronounced among subjects without cardiovascular disease (CVD), suggesting that the results were not driven by the possibility that less-fit individuals had greater CVD. Cost savings attributable to higher fitness were greatest in overweight and obese subjects, with lower savings observed among those individuals with a body mass index less than 25 kg/m2. In a model including historical, clinical, and exercise test responses, heart failure was the strongest predictor of health care costs, followed by CRF (P<.01). CONCLUSION: Low CRF is associated with higher health care costs. Efforts to improve CRF may not only improve health but also result in lower health care costs. Published by Elsevier Inc.
Authors: Marco Bernardi; Anna Lucia Fedullo; Elisabetta Bernardi; Diego Munzi; Ilaria Peluso; Jonathan Myers; Florigio Romano Lista; Tommaso Sciarra Journal: World J Gastroenterol Date: 2020-05-28 Impact factor: 5.742
Authors: James E Peterman; Ross Arena; Jonathan Myers; Susan Marzolini; Philip A Ades; Patrick D Savage; Carl J Lavie; Leonard A Kaminsky Journal: J Am Heart Assoc Date: 2021-11-08 Impact factor: 5.501