Incidence and Early Outcomes of Heart Failure in Commercially Insured and Medicare Advantage Patients, 2006 to 2014

H eart failure (HF) affects >5.7 million individuals in the United States 1 with 870 000 individuals newly diagnosed each year. 2 Previous epidemiological studies have demonstrated that the incidence of HF varies by race and ethnicity, with the highest incidence in blacks. 344]5 However, this association is partially mediated by differences in socioeconomic factors, 3 such as access to care, and whether differences extend to commercially insured populations requires examination.Furthermore, although the incidence of HF is known to increase with age, 6,7 younger individuals with HF remain understudied because several large epidemiological cohorts 8 and claims-based studies 6 are restricted to older individuals.Our goal was to address these gaps in knowledge by leveraging a large US insurance claims database, containing information from >100 million individuals enrolled in private and Medicare Advantage health plans.The objectives of this study were to evaluate the incidence of HF by age, sex, and race/ ethnicity and to examine differences in the rate of hospitalizations and office visits in the year after diagnosis. Methods and Results Data SourceWe conducted a retrospective analysis using the OptumLabs Data Warehouse, a large US commercial insurance database. 9The database comprises medical claims for individuals in all 50 states and of all ages and ethnic and racial groups. 10Medical claims include claims for professional (eg, physician), facility (eg, hospital), and outpatient prescription medication services.Pursuant to the Health Insurance Portability and Accountability Act, the use of de-identified data does not require Institutional Review Board approval. Study PopulationWe included adult enrollees for whom a diagnosis of HF (International Classification of Diseases, Ninth Revision, Clinical Modification codes 428.XX, 402.X1, 404.X1, or 404.X3 6 appeared on a single inpatient claim between January 1, 2006 and April 1, 2014.We also included individuals with an HF diagnosis on at least 3 physician or outpatient claims on different days within 20 consecutive months. 6The incidence date was defined as the earliest discharge date of the qualifying inpatient claim or the latest service date of the qualifying outpatient claim.To ensure that enrollees had newly diagnosed HF, we required them to have at least 2 previous years of continuous medical coverage with no claim listing HF as a diagnosis.