TY - JOUR
T1 - Comorbid diabetes and end-of-life expenditures among medicare beneficiaries with heart failure
AU - Blecker, Saul
AU - Herbert, Robert
AU - Brancati, Frederick L.
N1 - Funding Information:
Funding: National Heart, Lung, and Blood Institute grant 5T32HL007024 (Dr. Blecker) and National Institute of Diabetes and Digestive and Kidney Diseases grants K24DK62222 and P60KD079637 (Dr. Brancati).
PY - 2012/1
Y1 - 2012/1
N2 - Background: Diabetes is associated with increased risk of mortality in heart failure. We examined the association of diabetes with expenditures, hospitalizations, and procedures among Medicare beneficiaries with heart failure during the last 6 months of life. Methods and Results: In a 5% national Medicare sample, the prevalence of diabetes was 41.7% among 16,613 beneficiaries who died in 2007 with a diagnosis of heart failure. Diabetes was associated with higher expenditures during the last 6 months of life (mean $39,042 vs $29,003; P <.001), even after adjusting for covariates, including age, sex, race, geographic location, comorbidities, and preceding hospitalizations (cost ratio 1.08, 95% CI 1.05-1.12). For both diabetic and nondiabetic adults, more than one-half of Medicare expenditures were related to hospitalization costs (mean $22,516 vs $15,721; P <.001). Compared with their counterparts without diabetes, beneficiaries with diabetes had higher rates of hospitalization (adjusted incidence rate ratio 1.09, 95% CI 1.05-1.12) and days spent in the intensive care unit. Conclusions: Comorbid diabetes was common in heart failure and associated with higher expenditures, much of which was driven by increased rates of hospitalizations. Programs that focus on prevention of hospitalizations may reduce the substantial costs associated with heart failure near the end of life.
AB - Background: Diabetes is associated with increased risk of mortality in heart failure. We examined the association of diabetes with expenditures, hospitalizations, and procedures among Medicare beneficiaries with heart failure during the last 6 months of life. Methods and Results: In a 5% national Medicare sample, the prevalence of diabetes was 41.7% among 16,613 beneficiaries who died in 2007 with a diagnosis of heart failure. Diabetes was associated with higher expenditures during the last 6 months of life (mean $39,042 vs $29,003; P <.001), even after adjusting for covariates, including age, sex, race, geographic location, comorbidities, and preceding hospitalizations (cost ratio 1.08, 95% CI 1.05-1.12). For both diabetic and nondiabetic adults, more than one-half of Medicare expenditures were related to hospitalization costs (mean $22,516 vs $15,721; P <.001). Compared with their counterparts without diabetes, beneficiaries with diabetes had higher rates of hospitalization (adjusted incidence rate ratio 1.09, 95% CI 1.05-1.12) and days spent in the intensive care unit. Conclusions: Comorbid diabetes was common in heart failure and associated with higher expenditures, much of which was driven by increased rates of hospitalizations. Programs that focus on prevention of hospitalizations may reduce the substantial costs associated with heart failure near the end of life.
KW - Heart failure
KW - Medicare
KW - diabetes
KW - utilization
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U2 - 10.1016/j.cardfail.2011.09.011
DO - 10.1016/j.cardfail.2011.09.011
M3 - Article
C2 - 22196840
AN - SCOPUS:84855645157
SN - 1071-9164
VL - 18
SP - 41
EP - 46
JO - Journal of cardiac failure
JF - Journal of cardiac failure
IS - 1
ER -