High All-Cause Hospitalization Among Those With Recurrent ASCVD Event: Evidence From a Large-Scale Real-World Database
Author(s)
Sarah Sharman Moser, MSc1, Vishal Bali, MS, PhD2, Lori D. Bash, PhD2, Thibaut Galvain, PhD2, Moshe Hoshen, PhD1, Ran Numa, PhD3, Tal Patalon, MD1, Mohamed Safwat, MPH4, Gazit Sivan, MD1, Alberico L. Catapano, PhD5.
1Kahn Sagol Maccabi Research & Innovation Centre, Maccabi Healthcare Services, Tel Aviv, Israel, 2Merck & Co., Inc., Rahway, NJ, USA, 3MSD Company Ltd, Hod Hasharon, Israel, 4MSD IDEA Middle East, Dubai, United Arab Emirates, 5University of Milan & Multimedica IRCCS, Milan, Italy.
1Kahn Sagol Maccabi Research & Innovation Centre, Maccabi Healthcare Services, Tel Aviv, Israel, 2Merck & Co., Inc., Rahway, NJ, USA, 3MSD Company Ltd, Hod Hasharon, Israel, 4MSD IDEA Middle East, Dubai, United Arab Emirates, 5University of Milan & Multimedica IRCCS, Milan, Italy.
OBJECTIVES: Patients with history of an ASCVD event are at an increased risk of future ASCVD events. However, how overall all-cause hospitalization rates compare between those with recurrent ASCVD events and those with fewer ASCVD events is unknown.
METHODS: We examined deidentified electronic health records from Maccabi Health Services, a longitudinal nationwide health plan in Israel. We included adults who experienced their first non-fatal ASCVD event between ages 40-79 years and between 2006 and 2022. Patients were followed from their most recent ASCVD event until the end of 2023, death, or disenrollment (whichever came first). Using quasi-Poisson regression, we assessed the independent association between the combination of ASCVD events and the rate of all-cause hospitalization, adjusting for sociodemographic characteristics and comorbidities. All-cause hospitalization counts were calculated from periods between consecutive ASCVD events or end of follow-up (since their most recent event) and incidence rate ratios (IRRs) reported.
RESULTS: We followed 44,334 patients for an average of 7.2 years, with 197,443 hospitalizations observed. Patients with multiple MIs had higher subsequent hospitalization rates than those with one MI [IRR = 1.24 (1.18-1.30) for two MIs; IRR = 1.78 (1.67-1.90) for >=3 MIs]. Patients with Ischemic Stroke (IS) and PAD/carotid endarterectomy had higher hospitalization rates than those with one MI [IRR=1.44 (1.38-1.51) for one IS; IRR=2.25 (2.08-2.45) for >=2 IS; IRR=1.32 (1.22-1.42) for one PAD/carotid endarterectomy; IRR=2.27 (2.04-2.52) for >=2 PAD/carotid endarterectomy]. Risk was highest [IRR= (2.65 (2.50-2.80)] among patients with ASCVD affecting multiple arterial beds. Associations were observed independent of age, SES, sex, BMI, comorbidities and elevated LDL-C which were all associated with increasing risk of hospitalization.
CONCLUSIONS: Risk of hospitalizations increased with subsequent ASCVD events. Observations underscore the importance of risk reduction among those with a history of ASCVD to improve clinical outcomes and reduce healthcare utilization and costs.
METHODS: We examined deidentified electronic health records from Maccabi Health Services, a longitudinal nationwide health plan in Israel. We included adults who experienced their first non-fatal ASCVD event between ages 40-79 years and between 2006 and 2022. Patients were followed from their most recent ASCVD event until the end of 2023, death, or disenrollment (whichever came first). Using quasi-Poisson regression, we assessed the independent association between the combination of ASCVD events and the rate of all-cause hospitalization, adjusting for sociodemographic characteristics and comorbidities. All-cause hospitalization counts were calculated from periods between consecutive ASCVD events or end of follow-up (since their most recent event) and incidence rate ratios (IRRs) reported.
RESULTS: We followed 44,334 patients for an average of 7.2 years, with 197,443 hospitalizations observed. Patients with multiple MIs had higher subsequent hospitalization rates than those with one MI [IRR = 1.24 (1.18-1.30) for two MIs; IRR = 1.78 (1.67-1.90) for >=3 MIs]. Patients with Ischemic Stroke (IS) and PAD/carotid endarterectomy had higher hospitalization rates than those with one MI [IRR=1.44 (1.38-1.51) for one IS; IRR=2.25 (2.08-2.45) for >=2 IS; IRR=1.32 (1.22-1.42) for one PAD/carotid endarterectomy; IRR=2.27 (2.04-2.52) for >=2 PAD/carotid endarterectomy]. Risk was highest [IRR= (2.65 (2.50-2.80)] among patients with ASCVD affecting multiple arterial beds. Associations were observed independent of age, SES, sex, BMI, comorbidities and elevated LDL-C which were all associated with increasing risk of hospitalization.
CONCLUSIONS: Risk of hospitalizations increased with subsequent ASCVD events. Observations underscore the importance of risk reduction among those with a history of ASCVD to improve clinical outcomes and reduce healthcare utilization and costs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH125
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)