Abstract 151: Therapeutic Intensity in Medically Managed Incident Heart Failure Patients with and without Mitral Regurgitation: A Claims Based Analysis

Abstract

Background: Understanding the therapeutic intensity of medically managed heart failure (HF) patients with and without secondary MR can be challenging when using claims data. This research showcases the development of a therapeutic intensity score (TIS) and reports the impact of the score on annual all-cause inpatient hospitalizations. Methods: This study included data from the Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases from October 2011 to September 2016. Inclusion criteria were patients who had a minimum of 1 inpatient or 2 outpatient claims for HF with a 6-month pre-period (baseline). A 6-month post-period (landmark) after HF index was used to capture MR diagnosis and severity. Following the landmark period, patients were required to have 12 months of continuous medical and prescription drug plan enrollment with at least two records of HF medication refills. Additional exclusions (age under 18, chordal rupture, hospice, etc) were applied. TIS was calculated based on the patient’s pharmacologic regimen. Drug categories included but were not limited to: ACE inhibitors, angiotensin receptor blockers, beta blockers, and diuretics. Within drug categories, each prescription fill was assigned 1 point for low doses, 2 points for moderate doses, and 3 points for high doses. The highest point totals from each drug category were summated across categories with the maximum score being 24. HF patients were separated into three cohorts: without MR, not clinically significant MR (nsMR), and significant MR (sMR). Annual all-cause inpatient hospitalizations were modeled using the ordinary least squares method and MR, TIS, demographics, and comorbid conditions were included as covariates. Results: HF patients with sMR had the highest TIS at a mean of 6.9, followed by nsMR at 6.5 and no MR at 5.9. Based on the regression model, having clinically significant MR was associated with an increase (0.22 [0.05, 0.38]; P=0.0112) in annual all-cause inpatient hospitalizations. Additionally, every point increase of TIS was associated with an increase (0.20 [0.18, 0.21]; P<0.0001) in annual all-cause inpatient hospitalizations. Conclusion: While clinically significant MR is an important factor in healthcare utilization, the intensity of heart failure medication should also be considered when estimating the burden of illness. A 5 point increase in TIS is associated with an increase in one inpatient admission per year.