Incidence and medical resource utilization for cardiovascular events in Asia

Abstract

BACKGROUND: Cardiovascular events are the leading cause of mortality and morbidity in United States (US) and other industrialized countries. However, little is known about trends in the incidence and resource utilization of these conditions in Asia as life-style have westernized. OBJECTIVES: To describe the incidence (IR) and medical resource utilization of cardiovascular events among the study population in Hong Kong (HK), Taiwan (TW), Japan (JP) and US from 2006-2013. METHODS: We utilized the OMOP common data model in the AsPEN converted from a 1% random sample of Hong Kong Clinical Data Analysis and Reporting System (CDARS), a 5% random sample from Taiwan National Health Insurance Research Database (NHIRD), Japan Medical Data Center Database (JMDC), and 5% sample from the US Medicare database. Hospitalization and length of hospital stay for myocardial infarction (MI) or acute coronary syndrome (ACS) were identified from the databases. Comorbidities and concurrent medications for the patients at the time of the MI/ACS were assessed. RESULTS: The age-gender adjusted IR (per 100 persons) for MI/ACS were 0.2 in HK, 0.1 in JP and TW, and 0.9 in US. Average number of hospitalizations increased from 4.7-15.2 in HK, 0.8-1.1 in JP, 4.5-7.0 in US but slightly decreased in TW (10.8-10.0) over the study period. Average length of stay was increased by 14.5%-107.9% across the four countries. Congestive heart failure and hypertension were the most common comorbidities in these patients. Medications used after MI/ACS were quite different across sites: 93% of HK and 63% of TW patients started antiplatelet after MI/ACS vs. only 14% patients in JP and 0.1% in US. 61% patients in HK started renin-angiotensin system (RAS) inhibitors after diagnosis, whereas 22.1% and 38.3% patients in TW and US started the same treatment. CONCLUSIONS: The IR of MI/ACS were similar among different Asian sites but were higher in US. An increasing number of hospitalizations and length of stay suggested an increasing disease burden. Discrepancy in recommended drug use after MI/ACS provides additional insights into the variation across countries in treatment patterns that must be appreciated when undertaking multinational studies.