Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings.
Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings.
复制标题
DOI：
10.1161/circheartfailure.117.004402
复制
发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Berry JD
中科院分区：
文献类型：
--
作者：
Khera R;Pandey A;Ayers CR;Agusala V;Pruitt SL;Halm EA;Drazner MH;Das SR;de Lemos JA;Berry JD
为了评估心力衰竭（HF）流行的现状，并为医疗保险中未来的卫生政策干预提供目标，需要对其在住院和门诊护理环境中的流行病学进行当代评估。在2002-2013年全国5%的医疗保险受益人样本中，我们确定了一个由2，331，939名年龄≥65岁的独特的按服务收费医疗保险受益人组成的队列，这些受益人在10年期间（2004-2013年）随访了所有住院和门诊患者。既存HF定义为第一年内发生的任何HF，以及1例住院患者或2例门诊患者发生的HF事件。队列的平均年龄为72岁; 57%为女性，白色和黑色分别为86%和8%。在该队列中，518，223例患者既存HF，349，826例患者在研究期间新诊断为HF。在2004-2013年期间，HF事件发生率下降了32%，从每1000名受益人38.7例（2004年）下降到每1000名受益人26.2例（2013年）。相比之下，在我们的研究期间，HF患病率从162/1000（2004年）增加到172/1000受益人（2013年）（P趋势均<0.001）。最后，突发HF患者的1年总死亡率较高（24.7%），在研究期间每年绝对下降0.4%，住院患者与门诊患者相比，（P <0.001）近年来，医疗保险受益人中HF的流行病学发生了实质性变化，HF发病率下降，1年HF死亡率下降，而HF的总体负担继续增加。
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 2002-2013, 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). Pre-existing HF was defined by any HF encounter during the first year, and incident HF with either one inpatient or two 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 pre-existing HF, and 349,826 had a new diagnosis of HF during the study-period. During 2004-2013, the rates of incident HF declined 32%, from 38.7 per 1000 (2004) to 26.2 per 1000 beneficiaries (2013). In contrast, prevalent HF increased during our study period from 162 per 1000 (2004) to 172 per 1000 beneficiaries (2013) (Ptrend<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 vs outpatient setting (Pinteraction<.001) 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, while the overall burden of HF continues to increase.