Medicare Advantage patients with coronary artery disease (CAD) may be more likely to receive secondary prevention treatments than Medicare Fee-for-Service (FFS) beneficiaries with CAD, but these treatments may not improve outcomes, according to a study published Feb. 20 in JAMA Cardiology.

Jose F. Figueroa, MD, MPH, et al., used data from ACC's PINNACLE Registry to assess differences in delivery of evidence-based treatments and outcomes in 35,563 CAD patients enrolled in Medicare Advantage plans vs. 172,732 CAD patients in Medicare FFS plans. The primary study outcomes were prescriptions patterns among eligible patients and outcomes, including blood pressure and low-density lipoprotein cholesterol.

Results showed that Medicare Advantage beneficiaries received secondary prevention treatments more often than those in FFS plans – including beta blockers (80.6 percent vs. 78.8 percent); angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (70.7 percent vs. 65.1 percent); and statins (68.4 percent vs. 64.5 percent). Medicare Advantage patients were also more likely than FFS patients to receive all three medications when eligible (48.9 percent vs. 40.4 percent).

Those enrolled in Medicare Advantage plans also had greater odds of receiving guideline-recommended therapy for each medication individually and for all three medications combined than FFS beneficiaries. The study did not report significant differences in intermediate outcomes, such as systolic and diastolic blood pressure and low-density lipoprotein cholesterol levels.

The researchers suggest that Medicare Advantage plans may encourage greater uptake of process-based quality measures but that these may have a limited effect in improving patient outcomes. As more patients enroll in Medicare Advantage plans, continued monitoring of quality and outcomes will be necessary "to determine whether these patterns ultimately lead to better outcomes in Medicare," the authors conclude.

In an invited commentary, Paul A. Heidenreich, MD, MS, FACC, writes that the lack of improved outcomes among Medicare Advantage patients should not "supersede a benefit in a process of care that is shown to improve outcomes in randomized clinical trials," adding that research that combines process and outcomes metrics "will be more accurate and helpful to health system users."

Two related viewpoints also published in JAMA Cardiology addressed the changing role of registries as interest in real-world evidence increases. In the first viewpoint, Rachael L. Fleurence, PhD, et al., write that registries "have a long track record of producing high-quality evidence" but "need to keep adapting to a rapidly changing environment to leverage new opportunities and address future challenges." In the second viewpoint, Adrian F. Hernandez, MD, MHS, and Robert A. Harrington, MD, MACC, write that "cardiovascular medicine has led efforts to move registries beyond small-scale, local initiatives and expand across the entire U.S." but that these registries "will need to evolve to take advantage of changes in data flow and provide more real-time feedback to patients, clinicians, systems, regulators and policymakers."

“The NCDR continually modernizes and adapts to maximize the strengths of our cardiovascular registries, while continually addressing our challenges,” says Ralph G. Brindis, MD, MPH, MACC, NCDR senior medical officer and a past president of the ACC. “Challenges for discovering and harnessing more nimble data entry through EHR linkage and data extraction, along with other advanced methods for the population of registry data fields are needed and are being actively investigated by the NCDR. Leveraging multiple data sources for longitudinal outcomes assessment combined with the richness and clinical accuracy afforded by NCDR will continue to be a successful and cost-effective model in harnessing these multidimensional data sources to transform cardiovascular knowledge and improve care.”

Keywords: Medicare Part C, Coronary Artery Disease, Secondary Prevention, Cardiovascular Agents, Registries, National Cardiovascular Data Registries, PINNACLE Registry

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