Publications [#197979] of Daniel B. Mark

Papers Published

1. L Liao, KJ Anstrom, JS Gottdiener, PA Pappas, DJ Whellan, DW Kitzman, GP Aurigemma, DB Mark, KA Schulman, JG Jollis, Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study., American heart journal, vol. 153 no. 2 (February, 2007), pp. 245-52, ISSN 1097-6744 [doi]
   (last updated on 2011/11/29)

   Abstract:
   BACKGROUND: Although heart failure (HF) afflicts nearly 5 million Americans, the long-term cost of HF care has not been described previously. In a prospective, longitudinal cohort of community-dwelling elderly from 4 regions, we examined the long-term costs and resource use of elderly patients with HF. METHODS: We linked 4860 elderly participants in the National Heart, Lung, and Blood Institute Cardiovascular Health Study to Medicare part A and part B claims from 1992 to 2003. Costs were calculated from Medicare payments and discounted at 3% annually. We applied nonparametric estimators to calculate mean costs and resource use per patient for a 10-year period. To describe the relationship between patient characteristics and long-term costs, we constructed censoring-adjusted regression models. RESULTS: There were 343 participants (84.8% white; 50.1% men; mean age, 78.2 years) with prevalent HF and 4517 participants without HF at study entry. Mean follow-up was 6.7 years (median, 6.4 years). The 10-year survival rates were 33% and 63% for the prevalent HF and nonprevalent HF groups (P < .001), respectively. The mean 10-year medical costs were significantly higher for the prevalent HF cohort (54,704 dollars vs 41 dollars,780, P < .001). The higher costs associated with HF were also reflected in greater resource use with more hospitalizations (P < .05) and more intensive care unit days (P < .05). Participants with HF had more physician visits (P < .05), with most of these encounters involving noncardiology physicians. However, in multivariate models, prevalent HF was not an independent predictor of higher costs. CONCLUSIONS: Patients with HF consume substantially more health care resources than their elderly peers, and these higher costs persist through 10 years of follow-up. Many of these costs may be related to other comorbid conditions.

   Keywords:
   Aged • Costs and Cost Analysis • Female • Health Resources • Heart Failure • Humans • Male • Medicare • Prospective Studies • Time Factors • economics* • therapy* • utilization