Medical payments affect heart attack outcomes

Researchers from Beth Israel Deaconess Medical Center (BIDMC) analyzed if medical payments for acute myocardial infarction affects treatment outcomes for patients. Findings of this research are published in journal Circulation.

To cut down healthcare expenditure there has been a growing trend towards providing incentives to reduce cost at the same time maintaining acceptable outcomes. Hospital Value-Based Purchasing Program administered by the Centers for Medicare and Medicaid Services (CMS) is one such effort to reduce the cost of care. This program makes payments based on quality outcome measures for conditions such as acute myocardial infarction. Hospitals that perform poorly in these measures receive a reduced payment.

Researchers used national Medicare claims data and examined more than 640,000 hospitalizations involving patients 65 years or older hospitalized for heart attack and found that higher 30-day spending to care for Medicare beneficiaries with acute myocardial infarction was associated with a modest reduction inpatient mortality.

“Recent policy efforts have focused on improving the value of care, both in terms of total spending and patient outcomes,” said corresponding senior author Robert W. Yeh, MD, MSc, Director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center. “We need to understand whether programs like the Hospital Value-Based Purchasing Program are able to globally reduce spending and improve outcomes for acute conditions like acute myocardial infarction, or whether the strong incentive to reduce hospital spending has unintended adverse consequences.”

“These findings have important implications for patient care,” said first author Rishi K. Wadhera, MD, MPhil, an investigator at the Smith Center at Beth Israel Deaconess Medical Center and a cardiology fellow at Brigham and Women’s Hospital.Wadhera. “While this study found that increased spending was associated with better outcomes, not all spending is of equal value and further research is needed to find out why higher-spending hospitals have better outcomes.”

Citation: Wadhera, Rishi K., Karen E. Joynt Maddox, Yun Wang, Changyu Shen, Deepak L. Bhatt, and Robert W. Yeh. “Association Between 30-Day Episode Payments and Acute Myocardial Infarction Outcomes Among Medicare Beneficiaries.” Circulation: Cardiovascular Quality and Outcomes 11, no. 3 (2018). doi:10.1161/circoutcomes.117.004397.

Research funding: National Institute of Health

Adapted from press release by Beth Israel Deaconess Medical Center.

Cost of care for falls in elderly population

Researchers estimated medical costs attributable to both fatal and nonfatal falls in the elderly population and found that approximately 50 billion dollars were spent in 2015. These findings are published in the Journal of the American Geriatrics Society.

Researchers utilized population data from the National Vital Statistics System (NVSS) and cost estimates from the Web-based Injury Statistics Query and Reporting System (WISQARS) for fatal falls, quasi-experimental regression analysis of data from the Medicare Current Beneficiaries Survey (MCBS) for nonfatal falls.

For nonfatal falls in adults aged 65 and older, Medicare paid approximately $28.9 billion, Medicaid $8.7 billion and private and other payers $12.0 billion. Overall medical spending for fatal falls was estimated to be $754 million.

Study authors felt that”Preventive strategies that reduce falls among older adults could lead to a substantial reduction in health care spending.”

Citation: Florence, Curtis S., Gwen Bergen, Adam Atherly, Elizabeth Burns, Judy Stevens, and Cynthia Drake. “Medical Costs of Fatal and Nonfatal Falls in Older Adults.” Journal of the American Geriatrics Society, 2018. doi:10.1111/jgs.15304.

Research funding: CDC

Adapted from press release by Wiley publications.

Research shows Statins lower the risk of Alzheimer’s disease

The new study shows that, based on a sample of 399,979 Medicare beneficiaries, men and women who took statins two years or more lowered their risk of Alzheimer’s disease in the period spanning from 2009 to 2013. The incidence of Alzheimer’s disease was reduced for beneficiaries frequently prescribed statins (high users), compared to low users, USC and University of Arizona researchers found. Among women who were high users, the incidence rate was 15 percent lower. Among men, the rate was 12 percent lower.

Researchers found the risk of Alzheimer’s disease was reduced for Medicare beneficaries who were frequently prescribed statins. The risk reduction, measured by the hazard rate, varied by statin. Rates below 1 are statistically significant. Credit: USC Schaeffer Center and JAMA Neurology

Researchers noted that black men were the only group that did not show a statistically significant reduction in risk, likely due to sample size. “We may not need to wait for a cure to make a difference for patients currently at risk of the disease. Existing drugs, alone or in combination, may affect Alzheimer’s risk,” said lead and corresponding author Julie Zissimopoulos, associate director of the USC Leonard D. Schaeffer Center for Health Policy and Economics and assistant professor at USC Price School of Public Policy.

Prior studies have shown a link between cholesterol and the hallmark of Alzheimer’s disease: the beta-amyloid plaques that interfere with memory and other brain functions. “We looked to statins as a candidate because they are widely used and have resulted in the reduction of cholesterol,” she said. The findings were published in JAMA Neurology.

Although much is known about Alzheimer’s, scientists have been unsuccessful so far in developing effective treatments to prevent and slow the memory-erasing disease that affects more than 5 million Americans. Hopes were high for the experimental drug, solanezumab, by Eli Lilly that was designed to attack the amyloid plaques. The drug failed for patients with mild dementia in a recent large clinical trial.

In a previous study, Zissimopoulos found that if medical advances could delay the disease’s onset by a year, more than 2 million Americans would be spared from developing Alzheimer’s. This also would result in a $220 billion savings in health and caregiving costs by 2050. Zissimopoulos cautioned that a silver tsunami of aging baby boomers will increase the number of Alzheimer’s patients 70 and older to 9.1 million by 2050. Annual health care costs will surge to $1.5 trillion.

The research team divided the patients into two groups: high-use beneficiaries those who took statins for two years or more between 2006 and 2008 and low-use beneficiaries who took them less frequently or who started taking statins after 2008. Both sets of beneficiaries were in similar health and had no diagnosis of Alzheimer’s disease. The researchers studied records dating from 2009 to 2013 to track the onset of Alzheimer’s disease.

The estimated 400,000 Medicare beneficiaries who became the focus of the study were 65 and older as of January 2006 and were continuously enrolled in Medicare fee-for-service and Part D prescription drug coverage. The study sought results on four of the most commonly prescribed statins: simvastatin, atorvastatin, pravastatin and rosuvastatin.

The researchers also found a reduction in risk for certain demographic groups who were frequently prescribed statins for two years or more. The greatest drop in incidence of Alzheimer’s disease 29 percent was among Hispanic men. Among white men, high users of statins had an 11-percent lower risk of incidence of the disease. A similar reduction in risk  12-percent was found among Hispanic women.

The risk of Alzheimer’s disease was also lower for white women who were high users (15 percent lower than women who took statins less frequently). Simvastatin was linked to a reduced risk of Alzheimer’s for white women, Hispanic women and black women, as well as for white men and Hispanic men. Atrovastatin was associated with a reduced risk of Alzheimer’s for white women, Hispanic women, black women and Hispanic men. Pravastatin and rosuvastatin results showed a statistically significant reduction of Alzheimer’s risk for only white women.

Some scientists believe that certain statins such as atorvastatin and simvastatin, known as lipophilics, would be most effective as an Alzheimer’s preventive treatment because they cross the blood-brain barrier, a protective layer of cells that restricts the types of substances that can pass to the brain. “We generally found that they’re all associated with reduced risk,” Zissimopoulos said.

The researchers plan to study combinations of other existing drugs to measure their effects on the risk of Alzheimer’s disease.

Citation: Julie M. Zissimopoulos, Douglas Barthold, Roberta Diaz Brinton, Geoffrey Joyce. “Sex and Race Differences in the Association Between Statin Use and the Incidence of Alzheimer Disease”. JAMA Neurology 2016 vol: 111 (5) pp: 390-400.
DOI: 10.1001/jamaneurol.2016.3783
Research funding: NIH/National Institute on Aging, USC Zumberge Research Fund.