CVD Outcomes Among American Indian and Alaska Native Medicare Beneficiaries
- American Indian and Alaska Native Medicare beneficiaries carry a high prevalence of CVD with half of all patients experiencing ≥1 CV conditions (CAD, HF, AF, or stroke/TIA).
- From 2015–2019, CAD prevalence decreased, while MI and HF incidence increased. The overall mortality rate was nearly 20% for the entire cohort.
- Rates of CV risk factors were elevated with 45% of the cohort having diabetes and over 70% diagnosed with hypertension.
What are the incidence and prevalence of cardiovascular disease (CVD), associated risk factors, and mortality rates among American Indian and Alaska Native patients with Medicare insurance?
The investigators used a population-based cohort study design to examine Medicare administrative data (January 2015–December 2019), including American Indian and Alaska Native Medicare beneficiaries (aged ≥65 years) enrolled in both part A and B fee-for-service Medicare. The primary outcomes of interest were the annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]).
A total of 220,598 American Indian and Alaska Native Medicare beneficiaries were included in the present analysis. The median (interquartile range) age was 72.5 (68.5-79.0) years, 127,402 were female (57.8%), and 78,438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. A total of 98,833 (44.8%) patients were diagnosed with diabetes, 135,124 (61.3%) had hyperlipidemia, and 159,365 (72.2%) were diagnosed with hypertension during the study period.
The prevalence of CAD was 38.6% (61,125 patients) in 2015 and 36.7% (68,130 patients) in 2019 (p < 0.001). The incidence of acute myocardial infarction (MI) increased from 6.9 per 1,000 person-years in 2015 to 7.7 per 1,000 patient-years in 2019 (percentage change, 4.79%; p < 0.001). The prevalence of HF was 22.9% (36,288 patients) in 2015 and 21.4% (39,857 patients) in 2019 (p < 0.001). The incidence of HF increased from 26.1 per 1,000 person-years in 2015 to 27.0 per 1,000 person-years in 2019 (percentage change, 4.08%; p < 0.001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14,899 patients] vs. 2019: 9.3% [25,175 patients]). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1,000 person-years in 2015 and 12.1 per 1,000 person-years in 2019; percentage change, 5.08; p = 0.004).
Fifty percent of patients had ≥1 severe CV condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8%.
The authors concluded that in this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of CVD and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the CV health of this population.
These data support prior evidence of high rates of CVD and associated risk factors among American Indian and Alaska Native adults. Efforts to prevent CV risk factors and provide evidence-based management of CVD and associated risk factors are warranted.
Keywords: Alaskan Natives, Cardiometabolic Risk Factors, Diabetes Mellitus, Hypertension, Primary Prevention
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