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Research Article
7 October 2019

Twelve-month healthcare utilization and expenditures in Medicare fee-for-service patients with clinically significant mitral regurgitation

Abstract

Aim: This study sought to quantify the healthcare burden of Medicare patients with clinically significant mitral regurgitation (sMR). Materials & methods: Proxy definitions were used for sMR, including MR surgery, atrial fibrillation, pulmonary hypertension or >2 echocardiograms. Results: In this study, 11,173 patients had significant degenerative MR (sDMR); 25,402 had significant functional MR (sFMR); and 12,232 had significant uncharacterized MR (sUMR). Patients with sFMR (18,880) were more likely to be hospitalized and present to the emergency department compared with patients with sDMR (9,795) or sUMR (10,587). Annual healthcare expenditures for sMR patients were: US$29,328 for sFMR; US$17,112 for sUMR; and US$12,870 for sDMR. Conclusion: Novel therapeutic interventions merit further evaluation to reduce the substantial healthcare burden of sMR in the Medicare population.

Supplementary Material

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References

1.
Nishimura RA, Otto CM, Bonow RO et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation 135(25), e1159–e1195 (2017).
2.
Benjamin EJ, Blaha MJ, Chiuve SE et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 135(10), e146–e603 (2017).
3.
Nkomo VT, Gardin JM, Skelton TN et al. Burden of valvular heart diseases: a population-based study. Lancet 368(9540), 1005–1011 (2006).
4.
Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet 373(9672), 1382–1394 (2009).
5.
Helms AS, Bach DS. Heart valve disease. Prim. Care 40(1), 91–108 (2013).
6.
Bach DS, Awais M, Gurm HS et al. Failure of guideline adherence for intervention in patients with severe mitral regurgitation. J. Am. Coll. Cardiol. 54(9), 860–865 (2009).
7.
Carabello BA. The current therapy for mitral regurgitation. J. Am. Coll. Cardiol. 52(5), 319–326 (2008).
8.
Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J. Am. Coll. Cardiol. 65(12), 1231–1248 (2015).
9.
Hussaini A, Kar S. Percutaneous mitral valve repair: potential in heart failure management. Curr. Heart Fail. Rep. 7(1), 22–26 (2010).
10.
de Marchena E, Badiye A, Robalino G et al. Respective prevalence of the different carpentier classes of mitral regurgitation: a stepping stone for future therapeutic research and development. J. Card. Surg. 26(4), 385–392 (2011).
11.
Ahmed MI, McGiffin DC, O'Rourke RA et al. Mitral regurgitation. Curr. Probl. Cardiol. 34(3), 93–136 (2009).
12.
Moore M, Chen J, Mallow PJ et al. The direct health-care burden of valvular heart disease: evidence from US national survey data. Clinicoecon. Outcomes Res. 8, 613–627 (2016).
13.
National Center for Health Statistics (US). Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD, USA (2016).
14.
McCullough PA, Philbin EF, Spertus JA et al. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J. Am. Coll. Cardiol. 39(1), 60–69 (2002).
15.
Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur. Heart J. 31(16), 1958–1966 (2010).
16.
Dziadzko V, Clavel MA, Dziadzko M et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet 391(10124), 960–969 (2018).
17.
Goel SS, Bajaj N, Aggarwal B et al. Prevalence and outcomes of unoperated patients with severe symptomatic mitral regurgitation and heart failure: comprehensive analysis to determine the potential role of MitraClip for this unmet need. J. Am. Coll. Cardiol. 63(2), 185–186 (2014).
18.
Welp H, Martens S. Minimally invasive mitral valve repair. Curr. Opin. Anaesthesiol. 27(1), 65–71 (2014).
19.
Downs EA, Johnston LE, LaPar DJ et al. Minimally invasive mitral valve surgery provides excellent outcomes without increased cost: a multi-institutional analysis. Ann. Thorac. Surg. 102(1), 14–21 (2016).
20.
Stone GW, Lindenfeld J, Abraham WT et al. Transcatheter mitral-valve repair in patients with heart failure. N. Engl. J. Med. 379(24), 2307–2318 (2018).
21.
Vemulapalli S, Lippmann SJ, Krucoff M et al. Cardiovascular events and hospital resource utilization pre- and post-transcatheter mitral valve repair in high-surgical risk patients. Am. Heart J. 189, 146–157 (2017).
22.
Iung B, Baron G, Butchart EG et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur. Heart J. 24(13), 1231–1243 (2003).