Related Experiment Video
Updated: Aug 14, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Predictors of high-cost managed care patients with acute coronary syndrome
Lida R Etemad1, Patrick L McCollam
1i3 Magnifi, an Ingenix Company, 12125 Technology Dr., Eden Prairie, MN 55344, USA.
Insights
Predicting high-cost patients with acute coronary syndrome (ACS) is possible using patient characteristics. However, many predictors are non-modifiable comorbidities, suggesting opportunities for targeted interventions.
Area of Science:
- Health Economics
- Cardiology
- Health Services Research
Background:
- Acute coronary syndrome (ACS) represents a significant healthcare burden.
- Identifying high-cost patient populations is crucial for resource allocation and intervention strategies.
Purpose of the Study:
- To develop predictive models for identifying high-cost patients with new-onset acute coronary syndrome (ACS).
- To analyze demographic, disease, and treatment characteristics associated with high healthcare costs in ACS patients.
Main Methods:
- Retrospective analysis of administrative claims data from a large US managed care organization.
- ACS patients (unstable angina or acute myocardial infarction) were identified and followed for up to 12 months.
- Patients were categorized as high-cost (top 20%) or low-cost (bottom 80%) based on total healthcare expenditures; logistic regression was used for analysis.
Main Results:
- A total of 13,731 patients were analyzed, with varying types of ACS and a mean age of 54.2 years (68.2% male).
- Comorbidities (e.g., hypertension, diabetes, heart failure) and prior ACE inhibitor use were significant predictors of high costs.
- Revascularization during the index ACS episode, unlike during follow-up, decreased the odds of being high-cost (OR: 0.615).
Conclusions:
- Predictive models for high-cost ACS patients can be developed, though many key predictors are non-modifiable comorbidities.
- These findings suggest potential opportunities for payers and providers to implement targeted clinical and cost-saving interventions for high-risk individuals.
Objective:
To develop predictive models of high-cost acute coronary syndrome (ACS) patients using demographic, disease, and treatment characteristics.
Study Design:
This was a retrospective, administrative claims analysis utilizing pharmacy, medical, and eligibility data from a large US managed care organization.
Methods:
ACS was defined by ICD-9 codes for unstable angina (UA) or acute myocardial infarction (AMI). New onset patients (without ACS claims) in the prior six months were identified for the time period 07/01/99-06/30/01, and followed up to 12 months, health plan disenrollment, or death. Cost was measured as that incurred during the initial episode plus subsequent follow-up or during the subsequent follow-up only. Patients were dichotomized as high-cost (top 20%) or low-cost (bottom 80%), based on total costs. Logistic regression was used to examine the association for being classified as high-cost.
Results:
A total of 13 731 patients were included: 51.7% with UA, 39.6% with AMI and 8.7% with both UA and AMI. The mean age was 54.2 years and 68.2% were male. A number of co-morbidities (hypertension, diabetes, heart failure, etc.) predicted high-cost patients. Among medications, prior ACE inhibitor use predicted high-cost patients. While revascularization procedures, in general, were strong predictors of high-cost, revascularization during the index ACS episode (opposed to revascularization during the follow-up) decreased the odds of being high-cost (odds ratio [95% CI] 0.615 [0.506-0.748]).
Conclusion:
High-cost patients with new onset ACS can be predicted by some characteristics, but many of these characteristics are non-modifiable co-morbidities. Payers and providers may find opportunities for clinical and cost-saving interventions for these patients.
Related Concept Videos
01:26Acute Coronary Syndrome V: Nursing Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:30Coronary Artery Disease I: Introduction