title: Long-term cardiovascular risk and costs for myocardial infarction survivors in a US commercially insured population.
abstract: OBJECTIVE
  To quantify clinical and cost long-term outcomes in cardiovascular stable post-myocardial-infarction patients.
  
  
  METHODS
  Subjects with a history of myocardial infarction (MI) who were 50-64 years old and MI- and stroke-free for ≥12 months (index date) were identified in a large US claims database. Individuals were followed for up to 5 years (mean: 2.0 years) after their index date.
  
  
  METHODS
  Rates of MI, stroke, all-cause death, and a composite of these were analyzed via Cox regression models, adjusted for covariates. Results are reported for the overall population and the subgroups of those with type 2 diabetes, additional prior MI, and non-end-stage renal disease. As a secondary endpoint healthcare costs were evaluated at baseline and during each year of follow-up. Results Over the follow-up period, which averaged 2 years, 7.6% of all 13,492 subjects (10.5% vs. 5.4% with and without the selected risk factors, respectively) experienced at least one of the outcome events. The cumulative incidence rates over the entire follow-up period for the primary composite outcome were 20.8% and 12.2% for those with and without the selected atherothrombotic risk factors, respectively. The cardiovascular-related per-person-per-year healthcare costs during follow-up were higher in those with ≥1 additional risk factor compared to those without: $15,247 versus $7521. Costs were elevated over baseline costs throughout follow-up.
  
  
  CONCLUSIONS
  Administrative claims data lack clinical detail. Generalizability of results is limited to the US commercially insured population of a similar age to that included in this study.
  
  
  CONCLUSIONS
  High risk MI survivors who have been event free for ≥1 year remained at substantial risk of CV events and had increased healthcare costs for up to 5 years post-MI. These long-term risks have not been previously demonstrated in a working-age US population and suggest an unmet need for continuing secondary prevention long-term post-MI.
authors.affiliation: a HealthCore Inc. , Wilmington , DE , USA ;
authors.forename: David M
authors.initials: DM
authors.lastname: Kern
authors.affiliation: b AstraZeneca Pharmaceuticals , Mölndal , Sweden ;
authors.forename: Carl
authors.initials: C
authors.lastname: Mellström
authors.affiliation: c Evidera , Lexington , MA , USA ;
authors.forename: Phillip R
authors.initials: PR
authors.lastname: Hunt
authors.affiliation: a HealthCore Inc. , Wilmington , DE , USA ;
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tunceli
authors.affiliation: a HealthCore Inc. , Wilmington , DE , USA ;
authors.forename: Bingcao
authors.initials: B
authors.lastname: Wu
authors.affiliation: d AstraZeneca Pharmaceuticals , Melbourn , Hertfordshire , UK ;
authors.forename: Mogens
authors.initials: M
authors.lastname: Westergaard
authors.affiliation: b AstraZeneca Pharmaceuticals , Mölndal , Sweden ;|e Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics* / Q000453:epidemiology*; D002423:Cause of Death; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications / Q000191:economics / Q000453:epidemiology; D017741:Survivors; D016896:Treatment Outcome; D014481:United States
keywords: Claims data; coronary artery disease; cost; myocardial infarction