Advancing Value-Based Cardiovascular Care: The American Heart Association Value in Healthcare Initiative

Trends in Medicare Reimbursement for Adult Cardiothoracic Surgery Procedures: 2007 to 2020

Background. Cardiovascular disease has been the leading cause of death in the US for decades. Over half a million cardiothoracic surgery procedures are performed per year, with an increasingly aging population and rising healthcare costs. The purpose of this study was to evaluate trends in Medicare reimbursement rates from 2007 to 2020 for various cardiothoracic surgery procedures. Methods. The Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool was queried for common procedural terminology codes for 119 common cardiothoracic surgery procedures to obtain reimbursement data by year. Procedures were organized into cardiac, CABG, and thoracic subgroups. All monetary data were adjusted for inflation to 2020 US dollars. Adjusted data were analyzed to calculate compound annual growth rates (CAGR), average annual change, and total percent change for each procedure. Results. After adjusting for inflation, the reimbursement rates for cardiothoracic surgery procedures decreased by 10.20% on average. Reimbursement rates for cardiac, CABG, and thoracic surgical procedures decreased by 8.74%, 14.46%, and 10.94%, respectively. The mean annual change overall was −$14.47, and the CAGR was 0.82%. CABG procedures had the greatest decrease in CAGR (−1.11%), annual change (−$30.30), and total percent change (−14.46%). Conclusions. Medicare reimbursements for cardiothoracic surgery procedures steadily decreased from 2007 to 2020, with CABG procedures experiencing the highest percentage of decline. Dissemination of these findings is crucial to raising awareness for healthcare administrators, surgeons, insurance companies, and policymakers to ensure the accessibility of these procedures for high-quality cardiothoracic surgery care in the United States.

Association of depression and anxiety disorders with outcomes after revascularization in chronic limb-threatening ischemia hospitalizations nationwide

OBJECTIVE

Patients with chronic limb-threatening ischemia (CLTI), the end stage of peripheral artery disease, often present with comorbid depression and anxiety disorders. The prevalence of these comorbidities in the inpatient context over time, and their association with outcomes after revascularization and resource usage is unknown.

METHODS

Using the 2011 to 2017 National Inpatient Sample, two cohorts were created-CLTI hospitalizations with endovascular revascularization and CLTI hospitalizations with surgical revascularization. Within each cohort, the annual prevalence of depression and anxiety disorder diagnoses was determined, and temporal trends were evaluated using the Cochran-Mantel-Haenszel test. Hierarchical multivariable logistic and linear regression analyses were used to examine the association of depression and anxiety disorder diagnoses with inpatient major amputation, mortality, length of stay (LOS), and cost, adjusting for illness severity, comorbidities, and potential bias in the documentation of depression and anxiety disorder diagnoses stratified by patient sociodemographic data.

RESULTS

Across the study period were a total of 245,507 CLTI-related hospitalizations with endovascular revascularization and 138,922 with surgical revascularization. Hospitalizations with a depression or anxiety disorder diagnosis increased from 10.8% in 2011 to 15.3% in 2017 in the endovascular revascularization cohort and from 11.7% in 2011 to 14.4% in 2017 in the surgical revascularization cohort (P_trend < .001). In the endovascular revascularization cohort, depression was associated with higher odds of major amputation (odds ratio, 1.15; 95% confidence interval, 1.03-1.30). In addition, depression (9 vs 8 days [P < .001]; $105,754 vs $102,481 [P = .018]) and anxiety disorder (9 vs 8 days [P < .001]; $109,496 vs $102,324 [P < .001]) diagnoses were associated with a longer median LOS and higher median costs. In the surgical revascularization cohort, depression was associated with a higher odds of major amputation (odds ratio, 1.33; 95% confidence interval, 1.13-1.58) and a longer LOS (median, 9 vs 9 days; P = .004).

CONCLUSIONS

Depression and anxiety disorder diagnoses have become increasingly prevalent among CLTI hospitalizations including revascularizations. When present, these psychiatric comorbidities are associated with an increased risk of amputation and greater resource usage.

Heart Smart: A Virtual Self-Management Intervention for Homebound People With Heart Failure: A Pilot Study

Heart failure is a chronic medical condition that requires lifelong self-management to optimize health. Self-management strategies include self-monitoring symptoms, managing medications, modifying the diet, and maintaining healthy activity levels. However, knowledge of self-management skills is insufficient; people with heart failure must develop self-efficacy in order to take action to improve their health. Self-management programs rely on group interaction to build self-efficacy, but specialized group interventions are inaccessible to individuals who are homebound. The purpose of this pilot study was to examine the feasibility of Heart Smart, a 5-week, virtual program to increase self-efficacy for heart failure self-management. Three participants were enrolled from a large academic home health system in the greater Philadelphia area. All 3 participants demonstrated improved scores on the Self-Efficacy for Managing Chronic Diseases 6-Item Scale. Two out of the 3 participants had clinically important gains on the Kansas City Cardiomyopathy Questionnaire. All 3 participants made gains on the Atlanta Heart Failure Knowledge Test. Participants were able to log in and access the virtual meeting platform effectively with minimal training. Participant satisfaction within the group was high. These pilot study results indicate the potential for positive self-management gains, and larger scale trials of the Heart Smart intervention are recommended.

Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension

Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999-2000 to 48.5% in 2007-2008, it remained stable through 2013-2014 and declined to 43.7% in 2017-2018. To address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. Also, the group sought to identify opportunities to reverse the adverse trend and further improve hypertension control. The workshop immediately preceded the Surgeon General's Call to Action to Control Hypertension, which recognized a stagnation in progress with hypertension control. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities. The broad set of "big ideas" was comprised of various activities that may improve hypertension control, including: interventions to engage patients, promotion of self-measured BP monitoring with clinical support, supporting team-based care, implementing telehealth, enhancing community-clinical linkages, advancing precision population health, developing tailored public health messaging, simplifying hypertension treatment, using process and outcomes quality metrics to foster accountability and efficiency, improving access to high-quality health care, addressing social determinants of health, supporting cardiovascular public health and research, and lowering financial barriers to hypertension control.