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Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease
Barbara G Vickrey1, Thomas S Rector, Steven L Wickstrom
1RAND, Santa Monica, Calif, USA. bvickrey@ucla.edu
Insights
Individuals with existing atherosclerotic vascular disease face a high burden of subsequent ischemic events like stroke and heart attack. This highlights the critical need for effective secondary prevention strategies in managing atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Health Services Research
Background:
- Limited data exist on recurrent ischemic events in large managed care populations with established atherosclerotic vascular disease.
- Atherosclerotic vascular disease encompasses conditions like stroke, acute myocardial infarction (AMI), and peripheral arterial disease (PAD).
Purpose of the Study:
- To estimate the occurrence of secondary stroke, AMI, and vascular deaths in two large managed care samples.
- To assess the disease burden of subsequent ischemic events in patients with diagnosed atherosclerosis.
Main Methods:
- Utilized International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify patients aged 40+ with stroke, AMI, or PAD.
- Analyzed administrative data from commercial insurance and Medicare samples (1995-1998).
- Employed survival analysis to estimate cumulative occurrences of subsequent vascular events.
Main Results:
- In commercial cohorts, 3-year cumulative secondary event rates were 11.8% (stroke), 8.5% (AMI), and 6.5% (PAD).
- Medicare cohorts showed higher 3-year rates: 18.1% (stroke), 17.0% (AMI), and 8.7% (PAD).
- Secondary strokes predominated in stroke cohorts (>75%); secondary AMIs were most common in AMI and PAD cohorts (75% and 57%, respectively).
Conclusions:
- Subsequent ischemic events pose a significant burden for managed care enrollees with atherosclerotic vascular disease.
- Effective secondary prevention strategies are crucial for managing patients with diagnosed atherosclerosis.
Background And Purpose:
Few data exist for large managed care populations on the occurrence of subsequent acute ischemic events in persons with established atherosclerotic vascular disease. We estimated the occurrence of secondary stroke, acute myocardial infarction (AMI), and vascular deaths among 2 large, managed care samples.
Methods:
With the use of International Classification of Diseases, Ninth Revision, Clinical Modification codes, patients aged > or =40 years and with stroke, AMI, or peripheral arterial disease (PAD) were identified from administrative data of UnitedHealthcare plans during 1995-1998. Stroke, AMI, and PAD cohorts were identified within a commercial insurance sample and a Medicare sample. Cumulative occurrences of subsequent stroke, AMI, or vascular death were estimated by survival analysis.
Results:
In the stroke commercial cohort (n=1631; mean age, 62.1 years), cumulative occurrence of subsequent events was 4.2%, 6.5%, 9.8%, and 11.8% at 0.5, 1, 2, and 3 years, respectively; cumulative secondary event occurrence in the AMI commercial cohort (n=6458; mean age, 56.0 years) was 3.5%, 4.8%, 7.3%, and 8.5% and in the PAD commercial cohort (n=5813; mean age, 59.2 years) was 1.5%, 2.8%, 4.8%, and 6.5%, respectively. Cumulative secondary event occurrences were even higher in stroke (n=1518; mean age, 79.5 years), AMI (n=2197; mean age, 76.2 years), and PAD (n=5033; mean age, 76.6 years) cohorts of the Medicare sample: 18.1%, 17.0%, and 8.7%, respectively, at 3 years. More than 75% of each stroke cohort's secondary events were strokes; more than 75% of each AMI cohort's secondary events were AMIs. Of the PAD cohorts' secondary events, 27% to 39% were strokes, 48% to 57% were AMIs, and 13% to 16% were vascular deaths.
Conclusions:
Among these managed care enrollees with existing atherosclerotic vascular disease, subsequent ischemic events represent a significant symptomatic disease burden. Given these findings, it is very important to determine whether secondary prevention strategies are being effectively used to manage patients with diagnosed atherosclerosis.
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