title: Five-year clinical and economic outcomes among patients with medically managed severe aortic stenosis: results from a Medicare claims analysis.
abstract: BACKGROUND
  Patients with severe, symptomatic aortic stenosis, who do not undergo valve replacement surgery have a poor long-term prognosis. Limited data exist on the medical resource utilization and costs during the final stages of the disease.
  
  
  RESULTS
  We used data from the 2003 Medicare 5% standard analytic files to identify patients with aortic stenosis and a recent hospitalization for heart failure, who did not undergo valve replacement surgery within the ensuing 2 calendar quarters. These patients (n=2150) were considered to have medically managed severe aortic stenosis and were tracked over 5 years to measure clinical outcomes, medical resource use, and costs (from the perspective of the Medicare Program). The mean age of the cohort was 82 years, 64% were female, and the estimated logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) (a measure of predicted mortality with cardiac surgery) was 17%. During 5 years of follow-up, overall mortality was 88.4% with a mean survival duration of 1.8 years. During this time period, patients experienced an average of 4.4 hospital admissions, 52% were admitted to skilled nursing care, and 28% were admitted to hospice care. The total 5-year costs were $63 844 per patient, whereas mean annual follow-up costs (excluding the index quarter) per year alive were $29 278.
  
  
  CONCLUSIONS
  Elderly patients with severe aortic stenosis undergoing medical management have limited long-term survival and incur substantial costs to the Medicare Program. These results have important implications for policy makers interested in better understanding the cost-effectiveness of emerging treatment options such as transcatheter aortic valve replacement.
authors.affiliation: The Neocure Group, LLC, Washington, DC, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Clark
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.forename: Francis G
authors.initials: FG
authors.lastname: Duhay
authors.forename: Ann K
authors.initials: AK
authors.lastname: Thompson
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Keyes
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Stockwell
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000379:methods; D017051:Hospice Care / Q000191:economics; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics*; D018803:Models, Economic; D015999:Multivariate Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States