02656nas a2200433 4500008004100000022001400041245010700055210006900162260001300231300001100244490000700255520141500262653000901677653002201686653002101708653003401729653002001763653002601783653001101809653001101820653001701831653002401848653000901872653001301881653002301894653002601917653001201943653003101955653002401986653002402010653001802034100002202052700002402074700002002098700002202118700002402140700002302164856003502187 2007 eng d a1935-554800aCosts of the metabolic syndrome in elderly individuals: findings from the Cardiovascular Health Study.0 aCosts of the metabolic syndrome in elderly individuals findings  c2007 Oct a2553-80 v303 a

OBJECTIVE: The cardiovascular consequences of the metabolic syndrome and its component risk factors have been documented in elderly individuals. Little is known about how the metabolic syndrome and its individual components translate into long-term medical costs.

RESEARCH DESIGN AND METHODS: We used log-linear regression models to assess the independent contributions of the metabolic syndrome and its individual components to 10-year medical costs among 3,789 individuals aged > or = 65 years in the Cardiovascular Health Study.

RESULTS: As defined by the National Cholesterol Education Program Third Adult Treatment Panel report, the metabolic syndrome was present in 47% of the sample. Total costs to Medicare were 20% higher among participants with the metabolic syndrome ($40,873 vs. $33,010; P < 0.001). Controlling for age, sex, race/ethnicity, and other covariates, we found that abdominal obesity, low HDL cholesterol, and elevated blood pressure were associated with 15% (95% CI 4.3-26.7), 16% (1.7-31.8), and 20% (10.1-31.7) higher costs, respectively. When added to the model, the metabolic syndrome composite variable did not contribute significantly (P = 0.32).

CONCLUSIONS: Abdominal obesity, low HDL cholesterol, and hypertension but not the metabolic syndrome per se are important predictors of long-term costs in the Medicare population.

10aAged10aAged, 80 and over10aCholesterol, HDL10aContinental Population Groups10aCost of Illness10aDiabetic Angiopathies10aFemale10aHumans10aHypertension10aInterviews as Topic10aMale10aMedicare10aMetabolic Syndrome10aMultivariate Analysis10aObesity10aPatient Education as Topic10aProspective Studies10aRegression Analysis10aUnited States1 aCurtis, Lesley, H1 aHammill, Bradley, G1 aBethel, Angelyn1 aAnstrom, Kevin, J1 aGottdiener, John, S1 aSchulman, Kevin, A uhttps://chs-nhlbi.org/node/96903196nas a2200421 4500008004100000022001400041245013400055210006900189260001300258300001000271490000700281520196600288653000902254653002202263653002802285653001902313653002102332653001102353653002202364653002202386653001802408653001102426653002802437653000902465653002602474653003602500653001402536653002402550653001102574100002202585700002402607700002002631700002202651700001902673700002402692700002302716856003502739 2008 eng d a1473-487700aPancreatic beta-cell function as a predictor of cardiovascular outcomes and costs: findings from the Cardiovascular Health Study.0 aPancreatic betacell function as a predictor of cardiovascular ou c2008 Jan a41-500 v243 a

OBJECTIVE: To explore relationships between beta-cell function and incident cardiovascular events, death, and medical costs among elderly individuals.

RESEARCH DESIGN AND METHODS: In a prospective, population-based cohort of 4555 elderly individuals, we examined the effect of beta-cell function on incident cardiovascular events and mortality. We also examined costs for 3715 of these individuals. We used the computer-based homeostasis model assessment (HOMA) to calculate indices of beta-cell function (HOMA-%B) and insulin sensitivity (HOMA-%S) using baseline fasting glucose and insulin levels. All subjects were followed from 1992/1993 for 6 years or until death.

MAIN OUTCOME MEASURES: Discrete-time survival model of the effects of beta-cell function on incident cardiovascular events and all-cause mortality; and semiparametric estimators for calculations of mean 6-year costs.

RESULTS: Controlling for HOMA-%S, a 20% decrease in HOMA-%B was associated with increased odds of incident cardiovascular events (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.14) and death (OR, 1.10; 95% CI, 1.07-1.14). The relationships persisted after controlling for clinical and sociodemographic confounders. A 20% decrease in HOMA-%B was also associated with increased costs (cost ratio, 1.03; 95% CI, 1.01-1.05). The significant association did not persist after controlling for confounders.

LIMITATIONS: The sample comprises relatively healthy elderly individuals and is based on data from 1992 through 1999, which may not reflect current experience. The measure of beta-cell function is an estimate generated from single measures of glucose and insulin.

CONCLUSIONS: Beta-cell function as measured by HOMA-%B is a significant predictor of incident cardiovascular events and mortality but not of costs, controlling for HOMA-%S and sociodemographic and clinical confounders.

10aAged10aAged, 80 and over10aCardiovascular Diseases10aCohort Studies10aCoronary Disease10aFemale10aFollow-Up Studies10aHealth Care Costs10aHeart Failure10aHumans10aInsulin-Secreting Cells10aMale10aMyocardial Infarction10aOutcome Assessment, Health Care10aPrognosis10aProspective Studies10aStroke1 aCurtis, Lesley, H1 aHammill, Bradley, G1 aBethel, Angelyn1 aAnstrom, Kevin, J1 aLiao, Lawrence1 aGottdiener, John, S1 aSchulman, Kevin, A uhttps://chs-nhlbi.org/node/99902807nas a2200361 4500008004100000022001400041245010100055210006900156260001300225300001100238490000700249520176500256653000902021653002802030653001902058653001602077653001102093653001102104653000902115653001302124653004202137653003102179653002602210653001802236100002302254700002402277700002202301700002402323700002102347700001802368700002302386856003602409 2009 eng d a1537-194800aExternal validity of the cardiovascular health study: a comparison with the Medicare population.0 aExternal validity of the cardiovascular health study a compariso c2009 Aug a916-230 v473 a

BACKGROUND: The Cardiovascular Health Study (CHS), a population-based prospective cohort study, has been used to identify major risk factors associated with cardiovascular disease and stroke in the elderly.

OBJECTIVE: To assess the external validity of the CHS.

RESEARCH DESIGN: Comparison of the CHS cohort to a national cohort of Medicare beneficiaries and to Medicare beneficiaries residing in the CHS geographic regions.

SUBJECTS: CHS participants and a 5% sample of Medicare beneficiaries.

MEASURES: Demographic and administrative characteristics, comorbid conditions, resource use, and mortality.

RESULTS: Compared with both Medicare cohorts, the CHS cohort was older and included more men and African American participants. CHS participants were more likely to be enrolled in Medicare managed care than beneficiaries in the national Medicare cohort. Compared with the Medicare cohorts, mortality in the CHS was more than 40% lower at 1 year, approximately 25% lower at 5 years, and approximately 15% lower at 10 years. There were minimal differences in comorbid conditions and health care resource use.

CONCLUSION: The CHS cohort is comparable with the Medicare population, particularly with regard to comorbid conditions and resource use, but had lower mortality. The difference in mortality may reflect the CHS recruitment strategy or volunteer bias. These findings suggest it may not be appropriate to project absolute rates of disease and outcomes based on CHS data to the entire Medicare population. However, there is no reason to expect that the relative risks associated with physiologic processes identified by CHS data would differ for nonparticipants.

10aAged10aCardiovascular Diseases10aCohort Studies10aComorbidity10aFemale10aHumans10aMale10aMedicare10aRandomized Controlled Trials as Topic10aReproducibility of Results10aSocioeconomic Factors10aUnited States1 aDiMartino, Lisa, D1 aHammill, Bradley, G1 aCurtis, Lesley, H1 aGottdiener, John, S1 aManolio, Teri, A1 aPowe, Neil, R1 aSchulman, Kevin, A uhttps://chs-nhlbi.org/node/111303043nas a2200253 4500008004100000022001400041245016700055210006900222260000900291300002100300490000600321520221100327100002402538700001702562700002602579700002102605700002102626700001302647700002402660700002402684700002202708700002302730856003602753 2018 eng d a2050-312100aHospital and clinical care costs associated with atrial fibrillation for Medicare beneficiaries in the Cardiovascular Health Study and the Framingham Heart Study.0 aHospital and clinical care costs associated with atrial fibrilla c2018 a20503121187594440 v63 a

Background: Atrial fibrillation is increasingly prevalent as the US population ages and is associated with significant morbidity and mortality. Care for patients with atrial fibrillation can be costly, US health care costs are comparatively high, and there are few cost estimates available that incorporate detailed measurement of comorbidities and their effects on costs.

Methods and Results: In the Cardiovascular Health Study and the Framingham Heart Study, participants aged 65 years or older with newly diagnosed atrial fibrillation were matched on age and follow-up time to referents free of atrial fibrillation. The total clinical and hospital medical costs paid by Medicare Parts A and B (drug costs from Medicare Part D costs were not included) in the year prior to diagnosis (or matching) were compared with costs in the following year. Estimates were adjusted for other medical conditions and adjusted to 2009 dollars. In the Cardiovascular Health Study, 513 participants were diagnosed with new-onset atrial fibrillation and survived 30 days post-atrial fibrillation diagnosis, and 513 referents (as a control cohort) were identified, with a mean age of 77 years. In the Framingham Heart Study, we identified 336 participants diagnosed with atrial fibrillation, who survived 30 days post-atrial fibrillation diagnosis and matched these participants to 336 referents. We compared these new-onset atrial fibrillation participants with referents, using a difference in difference design to account for both time trends and differences between the two groups. The adjusted incremental cost for participants with atrial fibrillation, compared with referents, was US$18,060 (95% confidence interval: US$14,965-US$21,155) in the Cardiovascular Health Study and US$20,012 (95% confidence interval: US$15,057-US$24,966) in the Framingham Heart Study. The pooled estimate was US$18,601 (95% confidence interval: US$15,981-US$21,234).

Conclusion: Atrial fibrillation was associated with increased costs in the year after diagnosis in two community-based cohorts, even after careful accounting for age, time period, and systematically measured comorbidities.

1 aDelaney, Joseph, Ac1 aYin, Xiaoyan1 aFontes, João, Daniel1 aWallace, Erin, R1 aSkinner, Asheley1 aWang, Na1 aHammill, Bradley, G1 aBenjamin, Emelia, J1 aCurtis, Lesley, H1 aHeckbert, Susan, R uhttps://chs-nhlbi.org/node/7677