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CVD Outcomes Among American Indian and Alaska Native Medicare Beneficiaries
Quick Takes
- 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.
Study Questions:
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?
Methods:
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]).
Results:
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%.
Conclusions:
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.
Perspective:
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.
Clinical Topics: Cardiovascular Care Team, Prevention, Hypertension
Keywords: Alaskan Natives, Cardiometabolic Risk Factors, Diabetes Mellitus, Hypertension, Primary Prevention
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