PRM11 - The Use of Real World Data to Define The Prevalence, Severity, and Etiology of Mitral Valve Regurgitation

Abstract

Mitral regurgitation (MR) is a common valvular disorder, defined as degenerative (DMR) or functional (FMR), and is definitively diagnosed using imaging records. We established a series of expert rules based on clinical definitions to use claims data, which lacks clinical documentation and imaging results, to classify DMR, FMR, and a third uncharacterized cohort (UMR), to determine severity, and to account for ischemia. Patients with MR were defined by a minimum of 1 inpatient or 2 outpatient claims for MR. FMR was defined by the presence of heart failure (HF) during 6-months baseline, or 6-month post-diagnosis (washout); DMR was defined as either the presence of chordal rupture or absence of HF and ischemia; UMR was defined by patients otherwise not meeting criteria for FMR or DMR. MR was considered significant (sMR) if there was a prior MR surgery, a diagnosis of atrial fibrillation or pulmonary hypertension, or by serial echocardiograms (per clinical guidelines). Definitions were tested in 2 databases: (1) the Medicare Fee for Service (FFS) Standard Analytic Files and (2) the Medicare Advantage portion of the Medical Outcomes Research for Effectiveness and Economics Registry (MORE2). Patient distribution between the FFS and MORE2 are shown respectively by etiology: (FMR: 34%; 43%, DMR: 42%; 31%, and UMR: 24%; 26%) with consistent distributions for sMR (sFMR: 70%, 59%; sDMR: 49%, 31%; sUMR: 51%, 38%) and ischemia in FMR patients for FFS and MORE2 (68.7%, 76%). Claims analysis of sMR using real world data enables payers to define utilization metrics, which is paramount given the high burden of this disorder. These definitions have resulted in distributions across etiology that are consistent with expectations from clinical literature. Observed differences between data sources are likely attributable to variation in patient populations.