TY - JOUR T1 - Predictors of self-report of heart failure in a population-based survey of older adults. JF - Circ Cardiovasc Qual Outcomes Y1 - 2012 A1 - Tanya R Gure A1 - Ryan J McCammon A1 - Christine T Cigolle A1 - Todd M Koelling A1 - Caroline S Blaum A1 - Kenneth M. Langa KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Awareness KW - Chi-Square Distribution KW - Comorbidity KW - Female KW - Health Knowledge, Attitudes, Practice KW - Health Status KW - Health Surveys KW - Heart Failure KW - Humans KW - Insurance Claim Review KW - Logistic Models KW - Male KW - Medicare KW - Odds Ratio KW - Patients KW - Predictive Value of Tests KW - Self Report KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims.

METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged ≥ 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6%. Self-report of HF and claims agreement was 87% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with ≥ 4 HF claims (OR, 2.74; 95% CI, 1.36-5.52). Blacks (OR, 0.28; 95% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model.

CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.

PB - 5 VL - 5 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22592753?dopt=Abstract U2 - PMC3370939 U4 - medicare claims/heart disease/self-reported health ER - TY - JOUR T1 - Prevalence of cognitive impairment in older adults with heart failure. JF - J Am Geriatr Soc Y1 - 2012 A1 - Tanya R Gure A1 - Caroline S Blaum A1 - Bruno J Giordani A1 - Todd M Koelling A1 - Andrzej T Galecki A1 - Susan J Pressler A1 - Scott L Hummel A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Chi-Square Distribution KW - Cognition Disorders KW - Cross-Sectional Studies KW - Demography KW - Female KW - Heart Failure KW - Humans KW - Logistic Models KW - Male KW - Medicare KW - Prevalence KW - United States AB -

OBJECTIVES: To determine the prevalence of cognitive impairment in older adults with heart failure (HF).

DESIGN: Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims.

SETTING: United States, community.

PARTICIPANTS: Six thousand one hundred eighty-nine individuals aged 67 and older.

MEASUREMENTS: An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups.

RESULTS: The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15%, and the prevalence of mild cognitive impairment was 24%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95% confidence interval = 1.14-2.02).

CONCLUSION: Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.

PB - 60 VL - 60 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22882000?dopt=Abstract U2 - PMC3445700 U4 - Cognition/Cognitive impairment/Cardiovascular disease/heart Diseases/epidemiology/dementia/PREVALENCE ER -