title: Disease-modifying therapy and hospitalization risk in heart failure patients.
abstract: OBJECTIVE
  To examine comorbidity and therapy use rates in a Medicaid population with heart failure (HF), evaluate hospitalization risk as a function of comorbidity and therapy use, and assess the impact of modification on costs to the Medicaid program.
  
  
  METHODS
  Historical prospective cohort study. Claims were from adult enrollees in Maryland Medicaid (managed care organization or fee-for-service) diagnosed with HF between 2005 and 2009.
  
  
  METHODS
  The end point was first hospitalization after index HF. Average hazard ratios (HRs) were estimated by multivariate weighted Cox regression. Budget impact of modifications was assessed using annual number-needed-to-treat calculations and external estimate of average cost of HF hospitalization.
  
  
  RESULTS
  Most patients were >45 years (71%), women (56%), and black (60%). Medication use: beta-blockers (26%), angiotensin-converting enzyme inhibitors and/or angiotensin II receptor antagonists (ACEi/ARBs) (29%), aldosterone antagonists (5%), and others including nitrates-hydralazine (37%). Nearly all (98%) were diagnosed with 1 or more comorbidities. Relative risk of hospitalization was higher with most, but not all, comorbidities investigated. ACEi/ARBs (HR, 0.77; CI, 0.73-0.81), beta-blockers (HR, 0.83; CI, 0.79-0.87), and other cardiovascular drugs (HR, 0.76; CI, 0.72-0.80) had beneficial effects. A 20% increase in the use prevalence of ACEi/ARBs and beta-blockers translated to annual Medicaid savings of at least $85 and $57 per HF patient, respectively.
  
  
  CONCLUSIONS
  Findings call attention to comorbidities and optimization of disease-modifying therapy in Medicaid patients with HF. Certain disease-modifying medications mitigated risk, but were used infrequently. Substantive outcome improvement and savings to Medicaid may be achieved with small changes in prescribing rates or comorbidity prevalence.
authors.forename: Fadia T
authors.initials: FT
authors.lastname: Shaya
authors.forename: Ian M
authors.initials: IM
authors.lastname: Breunig
authors.affiliation: Heart and Vascular Center, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail: mmehra.harvard@gmail.com.
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000191:economics* / Q000494:pharmacology; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D018166:Health Care Reform; D006301:Health Services Needs and Demand; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D014481:United States
chemical_list: D002317:Cardiovascular Agents