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Five-year Clinical and Economic Outcomes Among Patients With Medically Managed Severe Aortic Stenosis: Results From a Medicare Claims Analysis.
MedLine Citation:
PMID:  22949492     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background-Patients with severe, symptomatic aortic stenosis, who do not undergo valve replacement surgery have a poor long-term prognosis. Limited data exist on the medical resource utilization and costs during the final stages of the disease.Methods and Results-We used data from the 2003 Medicare 5% standard analytic files to identify patients with aortic stenosis and a recent hospitalization for heart failure, who did not undergo valve replacement surgery within the ensuing 2 calendar quarters. These patients (n=2150) were considered to have medically managed severe aortic stenosis and were tracked over 5 years to measure clinical outcomes, medical resource use, and costs (from the perspective of the Medicare Program). The mean age of the cohort was 82 years, 64% were female, and the estimated logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) (a measure of predicted mortality with cardiac surgery) was 17%. During 5 years of follow-up, overall mortality was 88.4% with a mean survival duration of 1.8 years. During this time period, patients experienced an average of 4.4 hospital admissions, 52% were admitted to skilled nursing care, and 28% were admitted to hospice care. The total 5-year costs were $63 844 per patient, whereas mean annual follow-up costs (excluding the index quarter) per year alive were $29 278.Conclusions-Elderly patients with severe aortic stenosis undergoing medical management have limited long-term survival and incur substantial costs to the Medicare Program. These results have important implications for policy makers interested in better understanding the cost-effectiveness of emerging treatment options such as transcatheter aortic valve replacement.
Authors:
Mary Ann Clark; Suzanne V Arnold; Francis G Duhay; Ann K Thompson; Michelle J Keyes; Lars G Svensson; Robert O Bonow; Benjamin T Stockwell; David J Cohen
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-4
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  -     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
The Neocure Group, LLC, Washington, DC; Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO; Edwards Lifesciences, LLC, Irvine, CA; The Burgess Group, LLC, Alexandria, VA; Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, OH; and the Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago IL.
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