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

Abstract

Background: 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.

Methods and results: 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) (P_trend <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 (P_interaction <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.

Keywords: Medicare; health policy; heart failure; hospitalization; incidence.

Figure 1

(A) Calendar-year trends in incidence and prevalence (pre-existing + incident) of heart failure in fee-for-service Medicare beneficiaries in a claims-based administrative cohort – defined in detail in Methods section. (B) Trends in incidence of overall, inpatient, and outpatient heart failure (P<.001 for all).

Figure 2

(A) Calendar-year trends in risk-adjusted 1-year mortality rate among patients with incident diagnosis of heart failure (reference year: 2004) (B) Calendar-year trends in risk-adjusted 1-year mortality rate among patients with inpatient and outpatient diagnoses of heart failure (reference year: 2004)

Figure 3

Trends in incidence of heart failure in subgroups of Medicare beneficiaries by (A) age, (B) Sex (age-adjusted), (C) Race (age-adjusted), and (D) US census regions (age-adjusted).

Figure 4

Trends in prevalence of heart failure in subgroups of Medicare beneficiaries by (A) Sex, (B) Race, and (C) US census regions.