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Biomedical subjects

Thomas S Rector

Publications and source records attributed to Thomas S Rector.

18 recordsLinked to original sources
PubMed2006

Influence of blood pressure on the effectiveness of a fixed-dose combination of isosorbide dinitrate and hydralazine in the African-American Heart Failure Trial.

OBJECTIVES: This study sought to assess the effect of baseline systolic blood pressure (SBP) and changes in SBP on the effectiveness of treatment with fixed-dose combination of isosorbide dinitrate and hydralazine (FDC I/H) in patients with heart failure (HF). BACKGROUND: Low SBP is a risk factor for adverse outcomes in patients with HF. However, FDC I/H lowered SBP in the A-HeFT (African-American Heart Failure Trial) and yet prolonged survival. Whether blood pressure (BP) lowering is critical to the efficacy of FDC I/H and whether a low BP limits its effectiveness is unclear. METHODS: The effects of FDC I/H on SBP and on mortality and hospitalization were compared in patients with a low or high baseline SBP using multivariable Cox regression models. The interaction between the effect of treatment and baseline SBP was examined. RESULTS: Mean +/- SD baseline SBP in all of the patients was 126 +/- 18 mm Hg. Patients with baseline SBP equal to or below the median (126 mm Hg) had features of more severe HF. Baseline SBP equal to or below the median was an independent risk factor for death (hazard ratio [HR] 2.09; 95% confidence interval [CI] 1.02 to 4.29) or first hospitalization for HF (HR 1.66; 95% CI 1.18 to 2.34). The FDC I/H treatment reduced BP in patients with SBP above the median but not in patients with SBP below 126 mm Hg. The FDC I/H treatment was associated with a similar decrease in mortality or hospitalization for HF in patients with SBP below the median and above the median. The effects of FDC I/H on mortality alone were also similar. CONCLUSIONS: In A-HeFT, patients with lower SBP had a greater risk but a similar relative benefit from the use of FDC I/H as those with higher SBP. The FDC I/H treatment did not reduce SBP in patients with low SBP. An asymptomatic low SBP should not be considered a contraindication to use of FDC I/H in patients with HF.

Adult↗
PubMed2006

Should patients with anemia and low normal or normal serum ferritin undergo colonoscopy?

BACKGROUND: Patients with unexplained iron deficiency anemia have a greater prevalence of colonic neoplasia, and should be evaluated for a colonoscopy. The approach to patients with anemia without iron deficiency remains unclear. OBJECTIVE: To compare the prevalence of colonic neoplasia in anemic patients with normal ferritin (>50 ng/mL), to those with ferritin < or =50 ng/mL, and nonanemic individuals. METHODS: Patients referred for colonoscopy for anemia evaluation were stratified into 3 groups: ferritin < or =50 ng/mL, 51-100 ng/mL, and >100 ng/mL. We compared these groups to each other, and to asymptomatic nonanemic individuals undergoing screening colonoscopy. The prevalence of advanced colonic neoplasia was determined for each group using existing records. RESULTS: During the study period, 414 patients who underwent colonoscopy for anemia evaluation and 323 nonanemic individuals who underwent colonoscopy for cancer screening met inclusion criteria. Study subjects were mostly men. The prevalence of advanced colonic neoplasia in subjects with ferritin 51-100 ng/mL was 7.2% (95% CI 2.4-17.9%), similar to 7.9% (95% CI 5.1-11.9%) in those with ferritin < or =50 ng/mL. The incidence of advanced colonic neoplasia in subjects with ferritin >100 ng/mL was 1.7% (95% CI 0.1-6.6%), similar to 1.2% (95% CI 0.4-3.3%) in the asymptomatic nonanemic group. After adjusting for age, patients with ferritin < or =50 ng/mL and 51-100 ng/mL were almost 5 times more likely to harbor advanced colonic neoplasia than the other groups. The addition of other laboratory parameters did not improve the predictive value of ferritin. CONCLUSION: A ferritin cutoff of 100 ng/mL can be used to determine the need for colonoscopy in men with anemia.

Aged↗
PubMed2006

Quality of life in advanced heart failure: role of mitral regurgitation.

BACKGROUND: Quality of life is increasingly used as an important end point in clinical trials of treatments for heart failure; thus, relationships between traditional clinical variables and quality of life need to be understood. Baseline data from an ongoing multi-institutional study of a surgically implanted cardiac support device (CorCap, Acorn Cardiovascular, Inc, St Paul, MN) positioned around the heart to halt progression of remodeling in patients with cardiomyopathy provide an opportunity to study the relationship between mitral regurgitation (MR) and quality of life in a group of relatively young patients. OBJECTIVE: The objective of this study was to determine whether the degree of MR correlates with quality of life in patients presenting with significant symptoms of heart failure. METHODS: Baseline MR was assessed by echocardiography and patients were stratified according to whether there was a clinical indication for mitral valve surgery. The effect of heart failure on quality of life was measured by the Minnesota Living with Heart Failure questionnaire (MLHF). The New York Heart Association class, exercise performance measured by peak oxygen consumption and the 6-minute walk test, and the SF-36 physical function measure were analyzed as potential mediating variables. RESULTS: Mean MR grade was 2 +/- 1.5 on a 0-to-4 (worst) scale (n = 260) and ejection fraction averaged 27% +/- 9%. Most patients (82%) had New York Heart Association class III symptoms. Peak oxygen consumption averaged 14.7 +/- 4.3 mL/kg per minute and average walking distance was 348 +/- 83 m. Median (quartile range) SF-36 physical function was 35 (20-50) on a 0-to-100 (best) scale. Median MLHF score was 61 (47.5-77) on a 0-to-105 (worst) scale. The degree of MR and having an indication for mitral valve repair were not associated with the patients' quality of life. Controlling for symptoms and functional measures, older age was independently associated with better quality of life. CONCLUSIONS: The degree of MR was not related to MLHF scores, suggesting that surgery to reduce MR might not have predictable effects on quality of life. Further studies are needed to understand why younger patients reported worse quality of life and how this observation could impact therapy.

Adult↗
PubMed2006

Relationships between clinical assessments and patients' perceptions of the effects of heart failure on their quality of life.

BACKGROUND: Hypothetically, most of the effects of heart failure on quality of life might be attributed to symptoms produced by the pathology. Relationships between measures of these concepts need to be quantified to test this conceptual model. METHODS AND RESULTS: Measurements of heart failure pathology and symptoms and quality of life as measured by the Minnesota Living with Heart Failure (MLHF) questionnaire at the 4-month visit in the Valsartan Heart Failure Trial were analyzed. Correlation and regression analyses corrected for estimated reliability of measurements were used to quantify relationships. The percentage of variance in dependent variables that was related to explanatory variables was summarized by the coefficient of determination (100 xR(2)) from regression models. Dyspnea at rest, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, fatigue, and New York Heart Association class were significantly related to MLHF scores. Combined, these symptoms explained 41% of the variation in MLHF scores. Controlling for symptoms, age explained an additional 4.5% of the variation in MLHF scores, whereas race, gender, and available comorbidities each explained <1%. Pathologic measures including ejection fraction, B-type natriuretic peptide, jugular venous distension, rales, peripheral edema, systolic blood pressure, creatinine, and hemoglobin were not strongly related to symptom assessments (combined R(2) = 17%) or MLHF scores (combined R(2) = 7%). CONCLUSION: Symptoms of heart failure explain a substantial proportion of the variation in the effects of heart failure on patients' quality of life as measured by the MLHF score. The effects of heart failure on quality of life can vary with age independently of symptoms. Pathologic measures of heart failure including some well-known correlates of the risk of hospitalization and death are not strongly related to symptoms or quality of life. Further studies are needed to understand the relationships between heart failure pathology and symptoms and to identify determinants of the effects of heart failure on patients' quality of life that were not related to symptoms.

Age Factors↗
PubMed2006

Nonpharmacologic care by heart failure experts.

BACKGROUND: Nonpharmacologic clinical management practices have not been studied widely in heart failure (HF). The purpose of this survey was to describe the practices of self-identified experts in HF to identify: topics with uniformity of practice (> or =75% agreement) and topics with variability in practice (no uniformity and 2 or more choices endorsed by >/=10% of respondents). METHODS AND RESULTS: An online survey of members of the Heart Failure Society of America (HFSA) actively engaged in clinical practice was conducted in Fall 2004. A total of 347 of the 1420 HFSA members in clinical practice (24.4%) responded to the survey. Of these, 321 completed the survey and 290 (90.3%) identified themselves as experts in HF. Areas in which there appears to be variability in practice include advising patients about: (1) sodium-restricted diet; (2) alcohol; (3) sexual activity; (4) increased swelling or weight gain, including use of a flexible diuretic regimen; and (5) palliative care. Providers vary in their treatment of risk factors and comorbid illnesses, the attention given to subtle losses of weight over time, beliefs about treatment adherence and ways to improve it, and opinions about the most important areas for patient education, and beliefs about health literacy. CONCLUSION: Research on which to base advice for HF patients is greatly needed.

Adult↗
PubMed2006

Validation of a risk score for dying within 1 year of an admission for heart failure.

BACKGROUND: Development of heart failure greatly reduces life expectancy. Accurate estimates of the risk of dying are needed in clinical practice and for risk adjustment in observational studies. A relatively simple risk score has been developed to determine the risk of dying within 1-year of an admission for heart failure. We wanted to evaluate the risk score's predictive validity. METHODS AND RESULTS: Data were abstracted from the electronic medical records of 769 patients admitted to the Minneapolis Veterans Administration medical center with a primary diagnosis of heart failure. Mortality within 1 year of admission was 25%. The c-index for the risk score was 0.71 (95% confidence interval 0.67-0.76). Similar to the original derivation cohort, mortality in risk score groups was 7% for a score lower than 60 (n = 44), 14% for 61 to 90 (n = 246), 26% for 91 to 120 (n = 222), 51% for 121 to 150 (n = 106), and 50% for scores greater than 150 (n = 8). CONCLUSION: A previously developed risk score for 1-year mortality after an admission for heart failure provided a moderate degree of discrimination in a validation cohort from a different setting. Mortality in risk score groups was consistent with the original patient cohort. These results support the validity of the risk score and its application to a different patient population.

Aged↗
PubMed2006

Microsatellite instability in interval colon cancers.

BACKGROUND & AIMS: Colon cancers that develop after a complete colonoscopy may be the result of "failure of colonoscopy" or rapid tumor growth. Tumors that develop via the mismatch repair gene pathway demonstrate rapid tumor growth. The aim of this study was to determine if interval colon cancers were more likely than noninterval cancers to result from the loss of function of mismatch repair genes and hence demonstrate microsatellite instability (MSI). METHODS: We searched our institution's cancer registry for interval cancers, defined as colon cancers that developed within 5 years of a complete colonoscopy. These were frequency matched in a 1:2 ratio by age and sex to patients with noninterval cancers (defined as colon cancers diagnosed on a patient's first recorded colonoscopy). Archived cancer specimens for all subjects were retrieved and tested for MSI. RESULTS: Of the 993 colon cancers diagnosed during the study period, 51 (5.1%) were identified as an interval cancer, and 112 subjects with noninterval cancer served as a comparison group. Study subjects were almost all men. MSI was found in 30.4% of interval cancers compared with 10.3% of noninterval cancers (P = .003). After adjusting for age, interval cancers were 3.7 times more likely to show MSI than noninterval cancers (95% confidence interval, 1.5-9.1). This association was strongest for tumors located in the distal colon (odds ratio, 17.5; P = .008). No difference in TNM stage at diagnosis, histologic type or grade, or 5-year survival was found between groups. CONCLUSIONS: Interval colon cancers were almost 4 times as likely as noninterval colon cancers to be associated with mismatch repair gene dysfunction.

Aged↗
PubMed2005

Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: results from Val-HeFT.

BACKGROUND: Anemia is known to be a prognostic marker for patients with heart failure. However, little is known about the prognostic value of changes in hemoglobin (Hgb) over time or about the causes of anemia. METHODS AND RESULTS: Retrospective analysis of Valsartan Heart Failure Trial data indicated that the quartile of patients with the biggest average decrease in Hgb over 12 months (from 14.2 to 12.6 g/dL) had significantly (P< or =0.01) increased risk of subsequent hospitalization (hazard ratio [HR], 1.47), morbid events (HR, 1.41), and death (HR, 1.6) compared with the quartile that exhibited little change in Hgb over 12 months (from 13.7 to 13.8 g/dL). Increasing Hgb was significantly associated with lower mortality in patients with (HR, 0.78) and without (HR, 0.79) anemia at baseline. Anemia at baseline and the changes in Hgb were independently associated with serum albumin, blood pressure, glomerular filtration rate, B-type natriuretic peptide, and C-reactive protein. Lack of anemia at baseline and increases in Hgb over 12 months were not associated with smaller left ventricular diameters or higher ejection fractions. CONCLUSIONS: Changes in Hgb over 12 months were inversely associated with subsequent risk of mortality and morbidity, independently of the effects of baseline anemia and other important predictors. Several factors were independently related to anemia at baseline and changes in Hgb, suggesting multiple causes of anemia in patients with heart failure. These findings raise important questions about the optimal level of Hgb in patients with moderate to severe heart failure and how to achieve them.

Aged↗
PubMed2005

Clinical and analytical considerations in the study of health status in device trials for heart failure.

BACKGROUND: Measures of health status (including symptoms, functional status, or quality of life) assess patients' experiences of their disease, and may therefore be used to quantify the benefits and risks of treatment. The aim of this article is to provide recommendations to regulatory agencies and research sponsors regarding the use of health status measures in medical device trials. METHODS AND RESULTS: A workshop jointly planned by the Heart Failure Society of America and the US Food and Drug Administration was convened in October 2003 in Washington, DC. A Working Group to address health status measures initiated its collaboration at the workshop and continued its efforts throughout the next year. The Working Group recommended assessment of health status in all studies of heart failure therapy. Standardized instruments known to be valid, reliable, responsive to changes, and available in the languages of target populations should be used. Minimizing bias may be accomplished by using blinded, independent evaluators; collecting multiple health status measures; using valid statistical methods; and creating a health status resource bank. CONCLUSION: Assessment of health status should be part of any device trial and should occur regardless of whether the device is intended as destination or bridging therapy. Health status endpoints should be chosen, collected, and analyzed with the same level of scientific rigor as traditional clinical endpoints. Regulatory agencies should require use of analytic methods that handle the complexity of health status data in addition to usual protocol protections.

Clinical Trials as Topic↗
PubMed2005

Pneumonia in nursing home residents: factors associated with in-home care of EverCare enrollees.

OBJECTIVES: To identify determinants of whether nursing home (NH) residents enrolled in EverCare were admitted to in-home intensive service days (ISDs) rather than a hospital when they were thought to have pneumonia. DESIGN: Retrospective cross-sectional. SETTING: EverCare operations in five metropolitan areas. PARTICIPANTS: EverCare enrollees admitted to ISDs or a hospital for suspected pneumonia in 2002. MEASUREMENTS: Member, nurse practitioner, physician, and NH characteristics extracted from EverCare's administrative data and Online Survey Certification and Reporting NH data. RESULTS: Multivariable logistic regression indicated that admission to ISDs (65% of cases) was positively associated with age (odds ratio (OR)=1.04. 95% confidence interval (CI) 1.03-1.04), advance directives not to hospitalize (OR=2.88, 95% CI=1.76-4.72), or perform cardiopulmonary resuscitation, 3.09 (2.44-3.91), and hours worked by the NH's registered nurses (OR=4.34, 95% CI=1.74-10.8). Admission to ISD was less likely on weekends (OR=0.30, 95% CI=0.21-0.43), when residents had renal insufficiency (OR=0.61, 95% CI=0.49-0.76), and when the resident was covered by Medicaid (OR 0.87, 95% CI=0.82-0.93). CONCLUSION: Exploration of ways to extend services to weekends, increased availability of registered nurse staff, attention to advance directives, and a better understanding of the role of Medicaid might increase the likelihood of caring for EverCare enrollees with suspected pneumonia in their NH.

Aged↗
PubMed2004

Direct medical costs attributable to acute myocardial infarction and ischemic stroke in cohorts with atherosclerotic conditions.

BACKGROUND: The cost of acute ischemic events in persons with established atherosclerotic conditions is unknown. METHODS: The direct medical costs attributable to secondary acute myocardial infarction (AMI) or ischemic stroke among persons with established atherosclerotic conditions were estimated from 1995-1998 data on 1,143 patients enrolled in US managed care plans. RESULTS: The average 180-day costs attributable to secondary AMI or stroke were estimated as USD 19,056 in the AMI cohort having a private insurance (commercial; n = 344), USD 16,845 in the AMI cohort having government insurance (Medicare, age >/=65 years; n = 200), USD 10,267 for stroke commercial (n = 108), USD 16,280 for stroke Medicare (n = 113), USD 15,224 for peripheral arterial disease commercial (n = 170), and USD 15,182 for peripheral arterial disease Medicare (n = 208). CONCLUSION: These estimates can be used to study the cost-effectiveness of interventions proven to reduce these secondary events.

Aged↗
PubMed2004

Specificity and sensitivity of claims-based algorithms for identifying members of Medicare+Choice health plans that have chronic medical conditions.

OBJECTIVE: To examine the effects of varying diagnostic and pharmaceutical criteria on the performance of claims-based algorithms for identifying beneficiaries with hypertension, heart failure, chronic lung disease, arthritis, glaucoma, and diabetes. STUDY SETTING: Secondary 1999-2000 data from two Medicare+Choice health plans. STUDY DESIGN: Retrospective analysis of algorithm specificity and sensitivity. DATA COLLECTION: Physician, facility, and pharmacy claims data were extracted from electronic records for a sample of 3,633 continuously enrolled beneficiaries who responded to an independent survey that included questions about chronic diseases. PRINCIPAL FINDINGS: Compared to an algorithm that required a single medical claim in a one-year period that listed the diagnosis, either requiring that the diagnosis be listed on two separate claims or that the diagnosis to be listed on one claim for a face-to-face encounter with a health care provider significantly increased specificity for the conditions studied by 0.03 to 0.11. Specificity of algorithms was significantly improved by 0.03 to 0.17 when both a medical claim with a diagnosis and a pharmacy claim for a medication commonly used to treat the condition were required. Sensitivity improved significantly by 0.01 to 0.20 when the algorithm relied on a medical claim with a diagnosis or a pharmacy claim, and by 0.05 to 0.17 when two years rather than one year of claims data were analyzed. Algorithms that had specificity more than 0.95 were found for all six conditions. Sensitivity above 0.90 was not achieved all conditions. CONCLUSIONS: Varying claims criteria improved the performance of case-finding algorithms for six chronic conditions. Highly specific, and sometimes sensitive, algorithms for identifying members of health plans with several chronic conditions can be developed using claims data.

Algorithms↗
PubMed2004

Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data.

OBJECTIVES: To develop a systems approach to identify, for further evaluation, patients with potential controlled substance misuse or mismanagement using software queries applied to administrative health claims data. STUDY DESIGN: Retrospective validation of the system using insurance claims. PATIENTS AND METHODS: Data from administrative health claims databases representing nearly 7 million individuals younger than 65 years were used by multidisciplinary expert panels to develop and validate controlled substance patterns of utilization requiring evaluation (CS-PURE) criteria. RESULTS: Thirty-four CS-PURE queries were developed in SAS and applied to administrative claims records to identify patients with potential controlled substance misuse or mismanagement. From these, we identified 10 CS-PURE with the highest expert agreement that intervention was warranted. Expert panel agree, ment that CS-PURE correctly identified cases ranged from 48% to 100%, with at least 50% agreement in 9 of 10 CS-PURE. The prevalence rates for CS-PURE ranged from 0.001% to 0.252%. This translates to identifying between 5 and 1116 patients for individual CS-PURE in a 500 000-member health plan. CONCLUSIONS: We developed and empirically validated a group of queries using CS-PURE to identify patients with potential controlled substance misuse or mismanagement that would warrant further evaluation by the treating physician, a quality assurance function, or the medical director. Claims-based CS-PURE identification is generalizable to most health insurers with access to medical and pharmaceutical claims records. Although CS-PURE are not direct measures of misuse, they can direct attention to potential problems to determine if intervention is needed.

Adolescent↗
PubMed2003

Effect of tiered prescription copayments on the use of preferred brand medications.

BACKGROUND AND OBJECTIVE: Health plans are increasingly using more open drug formularies that offer differential prescription copayments as an incentive to enrollees to use brands that plans prefer. How much this financial incentive affects use of preferred brands has not been widely reported. The aim of this study was to estimate the effect of tiered copayments on the choice between preferred and nonpreferred brand medications. MATERIALS AND METHODS: Longitudinal logistic regression analyses of pharmacy claims from 1998 and 1999 comparing concurrent groups that were or were not exposed to tiered copayments. SUBJECTS: Enrollees in four independent physician practice association model health plans who had pharmacy claims for angiotensin converting enzyme inhibitors (ACEI), proton pump inhibitors (PPI), or hydroxymethylglutaryl coenzyme A reductase inhibitors (STATINS). OUTCOME MEASURE: Change in the percentage of prescription claims that were for preferred brands. MAIN RESULTS: Regression adjusted estimates of the average net increase in the percentage use of preferred brands of ACEI, PPI and STATIN from first quarter 1998 to third quarter 1999 attributed to tiered prescription copayments were 13.3 (P = 0.001), 8.9 (P = 0.03), and 6.0 (P <0.001) percentage points, respectively. CONCLUSIONS: Tiered prescription copayments were associated with a significant shift from nonpreferred to preferred brand medications. This type of financial incentive can help purchasers providing open access drug benefits by steering use of medications toward lower cost brands. The clinical effects of changes in medication use brought about differential copayments warrant further investigation.

Aged↗
PubMed2003

Insights into problems obtaining care believed necessary as measured by the Medicaid Consumer Assessment of Health Plans Survey (CAHPS).

BACKGROUND: The Consumer Assessment of Health Plans Survey (CAHPS) is widely used to evaluate health plans; however there are few reports of Medicaid health plan efforts to improve performance as measured by CAHPS. OBJECTIVE: Data from CAHPS were analyzed to help plan administrators determine how they might address member reports of problems obtaining care they or their doctor believed necessary. STUDY DESIGN: Secondary analysis of cross-sectional survey data obtained from adults and children enrolled in 3 Medicaid health plans. METHODS: Cross-tabulations of CAHPS responses and follow-up questions asking enrollees to describe the problems they had obtaining care believed necessary. RESULTS: Problems obtaining care believed necessary were among the most frequently reported problems (13%-17% of adults, 9% of children). Problems obtaining a satisfactory personal doctor; receiving help when calling a physician's office; securing routine, urgent, and specialist care appointments as soon as desired; receiving referrals to specialists; obtaining behavioral health services and prescription medications; and problems with doctor communication were related to problems obtaining care believed necessary. Enrollees' descriptions of the problems corroborated observed relationships between CAHPS responses, and revealed dissatisfaction with doctors' care and lack of coverage for various services as additional contributors. CONCLUSIONS: Analyses of relationships between enrollee-reported problems obtaining care believed necessary and their responses to other CAHPS items and follow-up questions identified a number of plausible causes of this problem. Given the multifaceted nature of problems with obtaining care believed necessary, a plan of action that might substantially improve this predicament was not apparent. Additional information about how health plan operations influence CAHPS results and the effect of health plan interventions on CAHPS measurements are needed to facilitate use of these data for quality improvement.

Adult↗
PubMed2002

Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease.

BACKGROUND AND PURPOSE: Few data exist for large managed care populations on the occurrence of subsequent acute ischemic events in persons with established atherosclerotic vascular disease. We estimated the occurrence of secondary stroke, acute myocardial infarction (AMI), and vascular deaths among 2 large, managed care samples. METHODS: With the use of International Classification of Diseases, Ninth Revision, Clinical Modification codes, patients aged > or =40 years and with stroke, AMI, or peripheral arterial disease (PAD) were identified from administrative data of UnitedHealthcare plans during 1995-1998. Stroke, AMI, and PAD cohorts were identified within a commercial insurance sample and a Medicare sample. Cumulative occurrences of subsequent stroke, AMI, or vascular death were estimated by survival analysis. RESULTS: In the stroke commercial cohort (n=1631; mean age, 62.1 years), cumulative occurrence of subsequent events was 4.2%, 6.5%, 9.8%, and 11.8% at 0.5, 1, 2, and 3 years, respectively; cumulative secondary event occurrence in the AMI commercial cohort (n=6458; mean age, 56.0 years) was 3.5%, 4.8%, 7.3%, and 8.5% and in the PAD commercial cohort (n=5813; mean age, 59.2 years) was 1.5%, 2.8%, 4.8%, and 6.5%, respectively. Cumulative secondary event occurrences were even higher in stroke (n=1518; mean age, 79.5 years), AMI (n=2197; mean age, 76.2 years), and PAD (n=5033; mean age, 76.6 years) cohorts of the Medicare sample: 18.1%, 17.0%, and 8.7%, respectively, at 3 years. More than 75% of each stroke cohort's secondary events were strokes; more than 75% of each AMI cohort's secondary events were AMIs. Of the PAD cohorts' secondary events, 27% to 39% were strokes, 48% to 57% were AMIs, and 13% to 16% were vascular deaths. CONCLUSIONS: Among these managed care enrollees with existing atherosclerotic vascular disease, subsequent ischemic events represent a significant symptomatic disease burden. Given these findings, it is very important to determine whether secondary prevention strategies are being effectively used to manage patients with diagnosed atherosclerosis.

Adult↗
PubMedDate not supplied

Do drug benefits help Medicare beneficiaries afford prescribed drugs?

We surveyed a random sample of 1,500 elderly people with chronic diseases who were enrolled in eight Medicare+Choice plans with a zero-premium, dollars 200-dollars 300 annual drug benefit and no deductible. An estimated 32 percent did not fill a prescription or reduced a prescribed dosage because of out-of-pocket costs. Lower drug benefits, higher out-of-pocket costs, lower income, and poorer health were associated with underuse of medications. Drug benefits with high out-of-pocket costs might not be effective for beneficiaries who use medications for chronic diseases, especially those with low incomes.

Aged↗