Chapter 4: Cardiovascular Disease in Patients with Chronic Kidney Disease - PowerPoint Presentation

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Chapter 4: Cardiovascular Disease in Patients with Chronic Kidney Disease - PPT Presentation

2017 Annual Data Report Volume 1 Chronic Kidney Disease 2 vol 1 Figure 41 Prevalence of common cardiovascular diseases in patients with or without CKD 2015 Data Source Special analyses Medicare 5 sample Abbreviations AF atrial fibrillation AMI acute myocardial infarction CAD co ID: 1041768

ckd disease stage patients disease ckd patients stage cardiovascular status chronic medicare kidney analyses aged artery year 2015 source

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1. Chapter 4:Cardiovascular Disease in Patients with Chronic Kidney Disease2017 Annual Data ReportVolume 1: Chronic Kidney Disease

2. 2vol 1 Figure 4.1 Prevalence of common cardiovascular diseases in patients with or without CKD, 2015 Data Source: Special analyses, Medicare 5% sample. Abbreviations: AF, atrial fibrillation; AMI, acute myocardial infarction; CAD, coronary artery disease; CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; CVD, cardiovascular disease; HF, heart failure; PAD, peripheral arterial disease; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; VHD, valvular heart disease; VTE/PE, venous thromboembolism and pulmonary embolism.

3. 3vol 1 Table 4.1 Prevalence of (a) cardiovascular comorbidities & (b) annual incidence of cardiovascular procedures, by CKD status, age, race, & sex, 2015Cardiovascular comorbidities# Patients% PatientsOverall66-6970-7475-8485+WhiteBlk/Af AmOtherMaleFemaleAny CVD Without CKD1,102,41331.918.927.039.052.132.828.023.335.329.3Any CKD146,66365.852.058.567.676.466.961.757.769.862.1Coronary artery disease (CAD) Without CKD1,102,41315.69.613.919.422.416.112.311.720.811.6Any CKD146,66339.430.935.841.643.640.533.334.847.032.3Acute myocardial infarction (AMI) Without CKD1,102,4132.21.52.02.73.42.31.91.42.91.7Any CKD146,6639.78.39.19.710.910.08.27.311.58.0Heart failure (HF) Without CKD1,102,4136.13.04.37.213.66.26.94.26.45.9Any CKD146,66327.620.021.727.237.127.929.321.828.227.2Valvular heart disease (VHD) Without CKD1,102,4135.02.43.86.69.25.33.33.34.95.1Any CKD146,66313.68.110.014.218.514.210.310.713.613.6Cerebrovascular accident/transient ischemic attack (CVA/TIA) Without CKD1,102,4136.93.75.68.911.77.07.55.26.96.9Any CKD146,66317.512.715.018.620.517.518.615.417.717.3Peripheral artery disease (PAD) Without CKD1,102,4139.14.36.711.019.19.29.76.59.38.9Any CKD146,66324.917.520.625.531.625.324.420.926.523.5Atrial fibrillation (AF) Without CKD1,102,4139.64.16.912.519.610.34.85.110.88.7Any CKD146,66324.614.217.925.933.726.414.716.027.322.1Cardiac arrest and ventricular arrhythmias (SCA/VA) Without CKD1,102,4131.30.91.31.71.71.41.10.81.91.0Any CKD146,6634.23.54.04.64.24.34.42.85.72.8Venous thromboembolism and pulmonary embolism (VTE/PE) Without CKD1,102,4131.30.81.11.51.91.31.50.61.21.3Any CKD146,6634.13.83.64.14.64.15.12.44.04.2

4. 4vol 1 Table 4.1 Prevalence of (a) cardiovascular comorbidities & (b) annual incidence of cardiovascular procedures, by CKD status, age, race, & sex, 2015 (continued)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2015 with fee-for-service coverage for the entire calendar year. Abbreviations: AF, atrial fibrillation; AMI, acute myocardial infarction; Blk/Af Am, Black African American; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CAS/CEA, carotid artery stenting and carotid endarterectomy; CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; CVD, cardiovascular disease; HF, heart failure; ICD/CRT-D, implantable cardioverter defibrillators/cardiac resynchronization therapy with defibrillator devices; PAD, peripheral arterial disease; PCI, percutaneous coronary interventions; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; VHD, valvular heart disease; VTE/PE, venous thromboembolism and pulmonary embolism. (a) The denominators for overall prevalence of all cardiovascular comorbidities were Medicare enrollees aged 66+ by CKD status. (b) The denominators for overall prevalence of PCI and CABG were Medicare enrollees aged 66+ with CAD by CKD status. The denominators for overall prevalence of ICD/CRT-D were Medicare enrollees aged 66+ with HF by CKD status. The denominators for overall prevalence of CAS/CEA were Medicare enrollees aged 66+ with CAD, CVA/TIA, or PAD by CKD status.(b) Cardiovascular procedures# Patients% PatientsOverall66-6970-7475-8485+WhiteBlk/Af AmOtherMaleFemaleRevascularization – percutaneous coronary interventions (PCI) Without CKD171,6401.62.31.81.41.01.61.41.51.61.6Any CKD57,7882.43.02.92.51.72.42.22.22.52.1Revascularization – coronary artery bypass graft (CABG) Without CKD171,6401.11.61.41.10.31.10.51.11.30.7Any CKD57,7881.62.92.41.80.41.71.21.82.11.0Implantable cardioverter defibrillators & cardiac resynchronization therapy with defibrillator (ICD/CRT-D)Without CKD67,3660.50.80.80.70.20.50.60.50.80.4Any CKD40,5450.91.31.41.00.50.91.00.91.30.6Carotid artery stenting and carotid artery endarterectomy (CAS/CEA)Without CKD269,2240.60.70.70.70.30.60.40.50.60.5Any CKD79,7900.70.91.10.80.40.80.40.50.90.6

5. 5Table A. ICD-9-CM and ICD-10-CM codes for Chronic Kidney Disease (CKD) stagesICD-9-CM codeaICD-10-CM codeaStage585.1N18.1CKD, Stage 1585.2N18.2CKD, Stage 2 (mild)585.3N18.3CKD, Stage 3 (moderate)585.4N18.4CKD, Stage 4 (severe)585.5N18.5CKD, Stage 5 (excludes 585.6: Stage 5, requiring chronic dialysisb)CKD Stage-unspecifiedCKD Stage-unspecifiedFor these analyses, identified by multiple codes including 585.9, 250.4x, 403.9x & others for ICD-9-CM and A18.xx, E08.xx, E11.xx and other for ICD-10-CM.a For analyses in this chapter, CKD stage estimates require at least one occurrence of a stage-specific code, and the last available CKD stage in a given year is used. b In USRDS analyses, patients with ICD-9-CM code 585.6 or ICD-10-CM code N18.6 & with no ESRD 2728 form or other indication of end-stage renal disease (ESRD) are considered to have code 585.5 or N18.5

6. 6vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(a) Coronary artery disease (CAD)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

7. 7vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(b) Acute myocardial infarction (AMI)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

8. 8vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(c) Heart failure (HF)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

9. 9vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(d) Valvular heart disease (VHD)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

10. 10vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(e) Cerebrovascular accident/transient ischemic attack (CVA/TIA)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

11. 11vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(f) Peripheral arterial disease (PAD)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

12. 12vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(g) Atrial fibrillation (AF)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

13. 13vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(h) Sudden cardiac arrest and ventricular arrhythmias (SCA/VA) Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

14. 14vol 1 Figure 4.2 Probability of survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015(i) Venous thromboembolism and pulmonary embolism (VTE/PE)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.

15. 15vol 1 Table 4.2 Two-year survival of patients with a prevalent cardiovascular disease, by CKD status, adjusted for age and sex, 2014-2015 CKD StatusCardiovascular DiseaseNo CKD(%)CKD(%)Stages 1 to 2(%)Stage 3(%)Stages 4 to 5(%)CAD87.376.480.977.467.4AMI81.367.870.768.356.3HF75.364.268.665.455.1VHD86.172.276.272.961.3CVA/TIA83.372.777.774.362.2PAD81.272.075.873.461.7AF82.869.674.470.859.6SCA/VA84.968.573.268.755.1VTE/PE81.368.870.271.358.0Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013, with fee-for-service coverage for the entire calendar year. Abbreviations: AF, atrial fibrillation; AMI, acute myocardial infarction; CAD, coronary artery disease; CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; HF, heart failure; PAD, peripheral arterial disease; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; VHD, valvular heart disease; VTE/PE, venous thromboembolism and pulmonary embolism.

16. 16vol 1 Figure 4.3 Probability of survival of patients with a cardiovascular procedure, by CKD status, adjusted for age and sex, 2013-2015(a) Percutaneous coronary interventions (PCI)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on the index date, which was the date of the first procedure claim, with fee-for-service coverage for the entire year prior to this date. Abbreviations: CKD, chronic kidney disease.

17. 17vol 1 Figure 4.3 Probability of survival of patients with a cardiovascular procedure, by CKD status, adjusted for age and sex, 2013-2015(b) Coronary artery bypass grafting (CABG)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on the index date, which was the date of the first procedure claim, with fee-for-service coverage for the entire year prior to this date. Abbreviations: CKD, chronic kidney disease.

18. 18vol 1 Figure 4.3 Probability of survival of patients with a cardiovascular procedure, by CKD status, adjusted for age and sex, 2013-2015(c) Implantable cardioverter defibrillators/cardiac resynchronization therapy with defibrillator devices(ICD/CRT-D)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on the index date, which was the date of the first procedure claim, with fee-for-service coverage for the entire year prior to this date. Abbreviations: CKD, chronic kidney disease.

19. 19vol 1 Figure 4.3 Probability of survival of patients with a cardiovascular procedure, by CKD status, adjusted for age and sex, 2013-2015(d) Carotid artery stenting and carotid endarterectomy (CAS/CEA)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on the index date, which was the date of the first procedure claim, with fee-for-service coverage for the entire year prior to this date. Abbreviations: CKD, chronic kidney disease.

20. 20vol 1 Table 4.3 Two-year survival of patients with a cardiovascular procedure, by CKD status, adjusted for age and sex, 2013-2015 CKD StatusCardiovascular ProcedureNo CKD(%)CKD(%)Stages 1 to 2(%)Stage 3(%)Stages 4 to 5(%)PCI85.374.776.376.163.7CABG89.181.383.482.070.2ICD/CRT-D78.964.464.164.457.9CAS/CEA87.679.579.181.669.0Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on the index date, which was the date of the first procedure claim, with fee-for-service coverage for the entire year prior to this date. Abbreviations: CABG, coronary artery bypass grafting; CAS/CEA, carotid artery stenting and carotid endarterectomy; CKD, chronic kidney disease; ICD/CRT-D, implantable cardioverter defibrillators/cardiac resynchronization therapy with defibrillator devices; PCI, percutaneous coronary interventions.

21. 21vol 1 Table 4.4 Cardiovascular pharmacological treatments by (a) comorbidities and (b) procedures, by CKD status, 2015(a) Cardiovascular comorbidities % Patients # PatientsBeta- blockersStatinsP2Y12 inhibitorsWarfarinDirect Oral AnticoagulantsACEIs/ARBsAny CVD Without CKD239,80057.163.016.615.29.855.1Any CKD66,35468.068.020.718.310.961.5Coronary artery disease (CAD) Without CKD116,84668.175.726.311.77.960.5Any CKD39,68476.175.828.817.510.763.8Acute myocardial infarction (AMI) Without CKD16,54577.678.239.814.19.965.2Any CKD9,66683.579.039.719.112.365.4Heart failure (HF) Without CKD46,50972.560.616.922.113.463.4Any CKD28,20477.867.421.823.814.061.7Valvular heart disease (VHD) Without CKD37,49360.561.913.718.611.156.0Any CKD13,58574.969.821.524.614.162.6Cerebrovascular accident/transient ischemic attack (CVA/TIA) Without CKD52,48851.368.125.012.88.055.6Any CKD17,83067.473.130.016.810.962.1Peripheral artery disease (PAD) Without CKD69,92350.258.718.211.56.853.3Any CKD25,46067.068.025.716.39.860.8Atrial fibrillation (AF) Without CKD71,36869.457.88.940.827.853.2Any CKD24,50776.465.414.940.725.058.9Cardiac arrest and ventricular arrhythmias (SCA/VA) Without CKD9,95173.664.217.016.712.560.9Any CKD4,20582.070.925.426.015.265.1Venous thromboembolism and pulmonary embolism (VTE/PE) Without CKD9,58044.449.26.957.723.946.0Any CKD4,13760.958.611.954.523.455.5

22. 22 % Patients # PatientsBeta- blockersStatinsP2Y12 inhibitorsWarfarinDirect Oral AnticoagulantsACEIs/ARBsRevascularization – percutaneous coronary interventions (PCI) Without CKD1,73890.091.395.410.17.575.5Any CKD89993.289.296.613.311.673.6Revascularization – coronary artery bypass graft (CABG) Without CKD1,16793.892.938.620.09.368.2Any CKD60792.992.141.722.712.068.5Implantable cardioverter defibrillators & cardiac resynchronization therapy with defibrillator (ICD/CRT-D)Without CKD26388.675.722.431.924.778.7Any CKD28491.273.934.535.921.575.7Carotid artery stenting and carotid artery endarterectomy (CAS/CEA)Without CKD1,03458.380.852.98.89.462.2Any CKD40871.685.350.515.010.872.1vol 1 Table 4.4 Cardiovascular pharmacological treatments by (a) comorbidities and (b) procedures, by CKD status, 2015 (continued)Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2015 with fee-for-service and Part D coverage for the entire calendar year. Abbreviations: ACEIs/ARBs, Angiotensin converting enzyme inhibitors and angiotensin receptor blockers; AF, atrial fibrillation; AMI, acute myocardial infarction; CAD, coronary artery disease; CABG, coronary artery bypass grafting; CAS/CEA, carotid artery stenting and carotid endarterectomy; CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; CVD, cardiovascular disease; HF, heart failure; ICD/CRT-D, implantable cardioverter defibrillators/cardiac resynchronization therapy with defibrillator devices; PAD, peripheral arterial disease; PCI, percutaneous coronary interventions; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; VHD, valvular heart disease; VTE/PE, venous thromboembolism and pulmonary embolism.(b) Cardiovascular Procedures

23. 23vol 1 Figure 4.4 Heart failure in patients with or without CKD, 2015 Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2015 with fee-for-service coverage for the entire calendar year. Abbreviation: CKD, chronic kidney disease.

24. 24vol 1 Figure 4.5 Adjusted survival of patients by CKD and heart failure status, 2014-2015Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2013 with fee-for-service coverage for the entire calendar year. Survival was adjusted for age, sex, race, diabetic status, and hypertension status. Abbreviations: CKD, chronic kidney disease.

25. 25vol 1 Table 4.5 Prevalence of atrial fibrillation by stage of CKD, age, race, sex, and diabetic, hypertension, and heart failure status, 2015 Stage of CKD Total No CKDStages 1-2Stage 3Stages 4-5Unknown stage All CKD stages# Patients1,102,41316,00875,59513,95141,109 146,663Atrial fibrillation (Overall)9.621.525.527.723.1 24.6Age 66-694.111.515.516.913.0 14.270-746.916.918.521.616.4 17.975-8412.522.826.428.425.1 25.985+19.632.534.033.633.6 33.7Sex Male10.824.328.630.625.1 27.3Female8.718.722.725.221.2 22.1Race White10.323.427.430.224.7 26.4Black/African American4.812.714.917.214.0 14.7Other 5.113.616.817.615.2 16.0Comorbidity No diabetes8.820.725.027.822.9 24.2Diabetes12.922.226.127.523.5 25.1No hypertension3.911.915.516.311.1 13.3Hypertension14.222.526.428.325.0 25.8No heart failure7.313.414.914.514.4 14.5Heart failure44.649.552.148.250.8 51.0Data Source: Special analyses, Medicare 5% sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2015 with fee-for-service coverage for the entire calendar year. Abbreviations: CKD, chronic kidney disease.