Medicare beneficiaries with fewer cardiovascular risk factors may have lower expenditures

Older adults with fewer risk factors for cardiovascular disease had lower all-cause and cardiovascular disease-related inpatient, outpatient and total healthcare expenditures, according to an analysis of Medicare fee-for-service beneficiaries.

They also had a lower risk for all-cause and cardiovascular disease-related inpatient encounters compared with adults with more risk factors for cardiovascular disease.

Lead researcher Kristal J. Aaron, DrPH, MSPH, of the University of Alabama at Birmingham, and colleagues published their results online in the Journal of the American Heart Association on Feb. 1.

The researchers mentioned that the American Heart Association (AHA) developed the Life’s Simple 7 (LS7) measure to help reach the organization’s goal of improving the cardiovascular health of the U.S. population by 20 percent and reducing deaths from cardiovascular disease and stroke by 20 percent by 2020. The LS7 measures cardiovascular health based on cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol and glucose.

In this study, known as REGARDS, researchers enrolled 30,239 black and white adults between January 2003 and October 2007. They enrolled more blacks and residents from the Southeastern U.S. by design because those two populations have a higher risk for stroke mortality. They also linked participants’ data to Medicare claims.

For this analysis, the researchers examined 6,262 adults who were at least 65 years old at baseline and did not have electrocardiogram evidence of a previous MI and did not self-report a previous stroke, MI or coronary revascularization procedure. Participants were also required to have Medicare fee-for-service coverage for at least a year after their baseline visit.

The researchers baseline data through a telephone interview, in-home examination and self-administered questionnaires. After the telephone interview, trained healthcare professionals visited participants’ homes and gave them a physical examination and electrocardiogram, took inventory of their medication usage and collected blood and urine samples. They also left them questionnaires to complete and return by mail.

Of the participants, 17.2 percent had zero to one ideal LS7 factors, 31.1 percent had two ideal factors, 29.0 percent had three ideal factors, 16.4 percent had four ideal factors and 6.4 percent had five to seven ideal factors. Participants with more ideal LS7 factors were older and were less likely to be women, black, have an annual income less than $20,000, less than a high school education and be unmarried.

The researchers noted that participants with fewer than five ideal LS7 factors accounted for more than half of all inpatient costs each year as well as approximately one-third of total outpatient claims.

After the researchers adjusted for multiple variables, they found that having more ideal LS7 factors was associated with a lower risk for all-cause and cardiovascular disease-related inpatient encounters and cardiovascular disease-related outpatient encounters. However, they noted there was no association between the number of ideal LS7 factors and having an all-cause outpatient encounter.

After adjusting for multiple variables, participants with more ideal LS7 factors also had lower cardiovascular disease-related inpatient, outpatient and total healthcare expenditures.

If all Medicare beneficiaries had ideal levels for five to seven LS7 factors, the researchers estimated that it could lead to a $41.2 billion annual reduction in healthcare costs, although they noted that the savings would likely be larger than that estimate.

“The actual cost for persons with fewer than five to seven factors is almost certainly higher,” Aaron said in a news release. “Skilled nursing facility, home health and hospice care, durable medical supplies, and medications were excluded in this analyses; thus, our study was limited to inpatient and outpatient visits for beneficiaries with Medicare fee-for-service in the 2014 calendar year, so this is probably a very conservative estimate.”

The researchers cited a few limitations of the study, including that they only included adults who were at least 65 years old, had Medicare fee-for-service coverage and lived in community settings. Thus, the results might not be generalizable to younger adults and nursing home residents. They also mentioned that they only assessed LS7 factors once. In addition, they did not have data on diet for a substantial number of participants. Further, they noted that causal inferences should be made with caution.