In the Journals

Heart-healthy behaviors linked to reduced Medicare costs

Adherence to the American Heart Association’s seven ideal health metrics could save more than $41 billion a year in Medicare costs, recent data show.

The AHA’s Life’s Simple 7 is a composite measure of seven modifiable heart-healthy factors: cigarette smoking, physical activity, diet, BMI, BP, cholesterol and glucose levels.

“Most of the growth in health care spending over the past 2 decades has been linked to modifiable risk factors including [Life’s Simple 7],” Kristal J. Aaron, DrPH, MSPH, clinical data manager at the University of Alabama at Birmingham, and colleagues wrote. “CVD is a major contributor to health care utilization and expenditures, particularly among older adults.”

The study participants were Medicare beneficiaries (n = 6,262) aged at least 65 years with fee-for-service coverage and no prior history of CVD. Baseline was between 2003 and 2007, and participants’ Medicare expenditures within 1 year of baseline were analyzed.

Cohort demographics

Overall, 17.2% of participants had zero to one ideal Life’s Simple 7 factors, 31.1% had two, 29% had three, 16.4% had four and 6.4% had five to seven. Participants with fewer ideal factors were younger and more likely to be women, to be black, to have an annual income less than $20,000, to have less than a high school education and to be unmarried.

Individuals with more ideal factors had lower mean all-cause inpatient, outpatient and total expenditures and lower mean CVD inpatient, outpatient and total expenditures in the year after baseline. The RR of inpatient or outpatient encounters for participants with five to seven ideal LS7 factors was 0.55 (95% CI, 0.39-0.76) vs. participants with zero to one factors.

Participants with five to seven ideal Life’s Simple 7 factors had lower mean expenditures vs. those with zero to one factors (mean inpatient expenditures, $1,250 vs. $3,995; mean outpatient expenditures, $2,853 vs. $5,166; mean total expenditures, $4,111 vs. $9,147, respectively).

After multivariable adjustment, the mean cost difference for participants with five to seven ideal factors vs. zero to one factors was –$2,551 for inpatient (95% CI, –$3,667 to –$1,435), –$2,410 for outpatient (95% CI, –$3,089 to –$1,731) and –$5,016 for total expenditures (95% CI, –$6,577 to –$3,454), according to the Aaron and colleagues.

Behavior and cost

“Medicare beneficiaries with fee-for-service coverage and no previous history of CVD demonstrated that having fewer than five to seven ideal [Life’s Simple 7] factors accounted for more than half of inpatient costs and [approximately] 30% of outpatient costs,” the researchers wrote. “Furthermore, we estimated that the achievement of ideal levels for five to seven [Life’s Simple 7] factors for the entire Medicare population could result in a total potential annualized cost reduction of $41.2 billion.”

The study did not include costs from skilled nursing facilities, home health and hospice care, durable medical supplies and medications, and is likely a conservative estimate, the researchers wrote.

“Moreover, randomized controlled trials have demonstrated the benefits of multifaceted interventions (eg, smoking cessation, diet and exercise) on improvements in risk factors and CVD risk,” the researchers wrote. “Given the substantially higher health care utilization and costs among participants with worse [CV] health, the benefits of these interventions may extend to reduced health care utilization and costs.” – by Cassie Homer

Disclosure: The researchers report no relevant financial disclosures.