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.

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.

Keywords:

• Claims data
• coronary artery disease
• cost
• myocardial infarction

Declaration of funding

This study was funded by AstraZeneca.

Declaration of financial/other relationships

M.W., N.H, and C.M. have disclosed that they are employees of AstraZeneca. P.R.H. has disclosed that he is an employee of Evidera. D.M.K., O.T., and B.W. have disclosed that they are employees of HealthCore Inc., a company that received funding from AstraZeneca to help conduct this study.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.