Abstract 379: Trends in Coronary Revascularization Procedures among Medicare Beneficiaries between Fiscal Years 2010 and 2013

Abstract

Background: This study reports trends among Medicare beneficiaries (MB) in the volume and outcomes of coronary revascularization procedures (CRP) performed between fiscal year 2010 and 2013. Methods: This study examined both the Medicare Provider Analysis and Review Files and the Medicare Outpatient File to identify all MB undergoing a CRP; either coronary bypass graft (CABG) surgery or any percutaneous coronary intervention (PCI). The study population consists of 2,148,877 MBs. ICD-9 procedure codes were used to identify procedures. Diagnosis and present-on-admission codes were used to identify MBs presenting with acute myocardial infarction (STEMI or NSTEMI). Discharge status was used to calculated mortality rates. Findings: Over the study period, the number of CRP among MBs decreased annually from 568,744 to 510,277 (3.35% per year): any CABG surgery declined by 3.36% per year and PCI only admissions declined by 5.16% per year. Non-admission PCI episodes varied between 104,566 and 109,064 per year. Mortality rates declined for all major CRP groups, except for PCI only admissions (increased from 2.16% to 2.75%). The proportion of MBs presenting with STEMI or NSTEMI increased from 11.9% to 15.2% and from 17.2% to 23.7% of all CRP, respectively. Mortality rates were highest and increasing for MBs presenting with STEMI across all procedures. Conclusions: The overall volume of CRPs among MBs is declining and more MBs are presenting with an AMI, and overall mortality rates are increasing year over year.