Prevalence of Cardiovascular Disease in a Population-Based Cohort of High-Cost Health Services Users

Abstract Background Limited data exist on the prevalence of cardiovascular disease (CVD) and multimorbidity in contemporary cohorts of high-cost users (HCU) in Canada. We examined 1) the prevalence of CVD, and compare total health care costs among HCU with and without CVD; 2) the contribution of other comorbidities to costs among HCU with CVD; and 3) the trajectory of health costs in the years before and after becoming a HCU. Methods The study included adult Alberta patients in the Canadian Institutes of Health Research/Canadian Institute for Health Information Dynamic Cohort of Complex, High System Users between 2011/12 –2014/15. We examined total health care costs including hospital, ambulatory care, physician services, and drug costs. Results Among 88,536 HCU, 23.4% had no CVD, 28.9% were hospitalized with a primary, and 47.7% with a secondary diagnosis of CVD. Total health care costs were $2.0 Billion (20.4% non-hospital costs), $2.8 Billion (24.1% non-hospital costs), and $4.9 Billion (19.8% non-hospital costs) in the three groups. Many HCU with CVD were frail (74.2%), and had diabetes (33.8%) or COPD (27.9%), which contributed to higher costs and mortality. Health care expenditures in HCU with CVD were several times higher than per capita health expenditures in the years prior to, and following their inclusion in the dynamic high-user cohort. Conclusion CVD is very common in HCU of healthcare. HCU with CVD have high rates of frailty and multimorbidity. Further research is needed to identify and intervene earlier in order to flatten the cost curve in these complex patients.