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Lo T, MacMillan A, Oudit GY, Usman H, Cabaj JL, MacDonald J, Saini V, Sikdar KC. Long-term health care use and diagnosis after hospitalization for COVID-19: a retrospective matched cohort study. CMAJ Open 2023; 11:E706-E715. [PMID: 37582621 PMCID: PMC10435242 DOI: 10.9778/cmajo.20220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Knowledge pertaining to the health and health care utilization of patients after recovery from acute COVID-19 is limited. We sought to assess the frequency of new diagnoses of disease and health care use after hospitalization with COVID-19. METHODS We included all patients hospitalized with COVID-19 in Alberta between Mar. 5 and Dec. 31, 2020. Additionally, 2 matched controls (SARS-CoV-2 negative) per case were included and followed up until Apr. 30, 2021. New diagnoses and health care use were identified from linked administrative health data. Repeated measures were made for the periods 1-30 days, 31-60 days, 61-90 days, 91-180 days, and 180 and more days from the index date. We used multivariable regression analysis to evaluate the association of COVID-19-related hospitalization with the number of physician visits during follow-up. RESULTS The study sample included 3397 cases and 6658 controls. Within the first 30 days of follow-up, the case group had 37.12% (95% confidence interval [CI] 35.44% to 38.80%) more patients with physician visits, 11.12% (95% CI 9.77% to 12.46%) more patients with emergency department visits and 2.92% (95% CI 2.08% to 3.76%) more patients with hospital admissions than the control group. New diagnoses involving multiple organ systems were more common in the case group. Regression results indicated that recovering from COVID-19-related hospitalization, admission to an intensive care unit, older age, greater number of comorbidities and more prior health care use were associated with increased physician visits. INTERPRETATION Patients recovered from the acute phase of COVID-19 continued to have greater health care use up to 6 months after hospital discharge. Research is required to further explore the effect of post-COVID-19 conditions, pre-existing health conditions and health-seeking behaviours on health care use.
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Affiliation(s)
- Tkt Lo
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Andrew MacMillan
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Gavin Y Oudit
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Hussain Usman
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Jason L Cabaj
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Judy MacDonald
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Vineet Saini
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Khokan C Sikdar
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Udell JA, Brickman AR, Chu A, Ferreira-Legere LE, Sheth MS, Ko DT, Austin PC, Abdel-Qadir H, Ivers NM, Bhatia RS, Farkouh ME, Stukel TA, Tu JV. Primary Care Clinical Volumes, Cholesterol Testing, and Cardiovascular Outcomes. Can J Cardiol 2023; 39:340-349. [PMID: 36574928 DOI: 10.1016/j.cjca.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/07/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND It is unknown whether the annual number of primary care physician (PCP) unique outpatient assessments, which we refer to as clinical volume, translates into better cardiovascular preventive care. We examined the relationship between PCP outpatient clinical volumes and cholesterol testing and major adverse cardiovascular event rates among guideline-recommended eligible patients. METHODS This was a retrospective cohort study conducted as part of the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, a population-based cohort of almost all adult residents of Ontario, Canada, followed from 2008 to 2012. For each clinical volume quintile, we compared cholesterol testing and major adverse cardiovascular events, defined as time to first event of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS The 10,037 PCPs evaluated had an annualized median volume of 2303 clinical encounters (IQR 1292-3680). Among 4,740,380 patients, 84% underwent guideline-concordant cholesterol testing at least once over 5 years, ranging from 73% with the lowest clinical volume quintile physicians to 86% with the highest. After multivariable adjustment, there was a 10.5% relative increase in the probability of cholesterol testing for every doubling of clinical volumes (95% CI 9.7-11.4; P < 0.001). Patients treated by the lowest volume quintile physicians had the highest rate of major adverse cardiovascular outcomes (compared with the highest volume quintile physicians: adjusted HR 1.15, 95% CI 1.10-1.21; P < 0.001). CONCLUSIONS Patients of physicians with the lowest clinical volumes received less frequent cholesterol testing and had the highest rate of incident cardiovascular events. Further research investigating the drivers of this relationship is warranted.
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Affiliation(s)
- Jacob A Udell
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Arielle R Brickman
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Maya S Sheth
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dennis T Ko
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Husam Abdel-Qadir
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Thérèse A Stukel
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jack V Tu
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Tran DT, Palfrey D, Welsh R. The Healthcare Cost Burden in Adults with High Risk for Cardiovascular Disease. PHARMACOECONOMICS - OPEN 2021; 5:425-435. [PMID: 33484443 PMCID: PMC8333236 DOI: 10.1007/s41669-021-00257-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We calculated the short- and long-term care resource use and costs in adults with high-risk conditions for cardiovascular disease (HRCVD) as defined by the Canadian Cardiovascular Society dyslipidemia guidelines. METHODS We linked Alberta health databases to identify patients aged ≥ 18 years with HRCVD between fiscal year (FY) 2012 and FY2016. The first HRCVD event was the index event. Patients were categorized into (1) primary prevention patients and (2) secondary prevention patients at the index event and were followed until death, they moved out of the province, or they were censored at March 2018. We calculated the resource use and costs for each of the 5 years after the index event. RESULTS The study included 459,739 HRCVD patients (13,947 [3%] were secondary prevention patients). The secondary prevention patients were older (median age 61 years vs. 55 years; p < 0.001), and there were fewer females in this group (30.4% vs. 51.3%; p < 0.001). The total healthcare costs in the first year decreased over time (FY2012: 1.16 billion Canadian dollars (CA$); FY2016: CA$1.05 billion; p < 0.001). An HRCVD patient incurred CA$12,068, CA$5626, and CA$4655 during the first, second, and fifth year, respectively (p for trend < 0.001). During the first year, healthcare costs per secondary prevention patient (CA$36,641) were triple that for a primary prevention patient (CA$11,299; p < 0.001), primarily due to higher hospitalization costs in secondary prevention patients (CA$26,896 vs. CA$6051; p < 0.001). CONCLUSIONS The healthcare costs for HRCVD patients were substantial but decreased over time. The costs were highest in the year following the index event and decreased thereafter. Secondary prevention patients incurred higher costs than the primary prevention patients.
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Affiliation(s)
- Dat T Tran
- Institute of Health Economics, #1200-10405 Jasper Avenue, Edmonton, AB, T5J 3N4, Canada.
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Dan Palfrey
- Institute of Health Economics, #1200-10405 Jasper Avenue, Edmonton, AB, T5J 3N4, Canada
| | - Robert Welsh
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
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