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Long-term cardiovascular risk and costs for myocardial infarction survivors in a US commercially insured population
David M Kern1, Carl Mellström2, Phillip R Hunt3
1a HealthCore Inc. , Wilmington , DE , USA ;
Insights
Cardiovascular stable patients post-myocardial infarction (MI) face significant long-term risks of recurrent events and elevated healthcare costs, highlighting a need for ongoing secondary prevention strategies.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Epidemiology
Background:
- Myocardial infarction (MI) survivors often require long-term management.
- Understanding long-term clinical and economic outcomes is crucial for effective secondary prevention.
- Previous studies may not fully capture risks in working-age US populations.
Purpose of the Study:
- To quantify long-term clinical events (MI, stroke, death) and associated healthcare costs.
- To assess these outcomes in cardiovascularly stable post-MI patients aged 50-64.
- To identify risks in subgroups with type 2 diabetes, prior MI, or renal disease.
Main Methods:
- Retrospective analysis of a large US claims database.
- Inclusion of 13,492 patients aged 50-64, at least 12 months post-MI and free of stroke.
- Follow-up for up to 5 years using Cox regression for clinical events and cost analysis.
Main Results:
- 7.6% of subjects experienced at least one major adverse cardiovascular event.
- Cumulative incidence of composite outcomes was significantly higher in those with risk factors (20.8% vs. 12.2%).
- Annual cardiovascular healthcare costs were substantially higher for patients with additional risk factors ($15,247 vs. $7521).
Conclusions:
- High-risk myocardial infarction survivors remain at substantial risk for cardiovascular events and incur increased healthcare costs for up to 5 years post-MI.
- These findings underscore an unmet need for sustained secondary prevention in working-age populations.
- Limitations include the lack of clinical detail in claims data and generalizability to the US commercially insured population.
Objective:
To quantify clinical and cost long-term outcomes in cardiovascular stable post-myocardial-infarction patients.
Research Design And 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.
Main Outcome Measures:
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.
Limitations:
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.
