Assessing Risk of Future Cardiovascular Events, Healthcare Resource Utilization and Costs in Patients with Type 2 Diabetes, Prior Cardiovascular Disease and Both.

Background: Description of risk of cardiovascular (CV) events associated with diabetes is evolving. This US-based real-world study estimated risk of future CV events and heart failure (HF) from type 2 diabetes (T2DM)-only, prior CV events-only, or T2DM + prior CV events, versus controls, and evaluated healthcare resource utilization (HCRU) and costs.Methods and Materials: This retrospective cohort study queried claims and mortality data for 638,301 patients: T2DM-only (377,205); prior CV events-only (130,964); both T2DM + prior CV events (130,132); and matched (1:1) controls, during 01/01/2012-12/31/2012. Cardiovascular diagnoses/events and death were assessed individually, and as composite endpoint (MI, stroke, TIA, PAD), during follow-up, ending 07/31/2018.Results: Adjusting for age and gender, patients with T2DM-only were 1.6, prior CV events-only 2.5 and T2DM + prior CV events 3.8 times likelier to have primary composite CV events relative to controls, P < 0.001. HF development was elevated across all 3 cohorts. Adjusted results showed inpatient admissions for T2DM-only, CV events-only and T2DM + prior CV events were 1.37, 2.76 and 3.63 times greater than controls, respectively. All-cause healthcare costs were highest in the T2DM + prior CV events cohort ($2,783 per patient per month -PPPM) followed by the prior CV events-only ($1,910 PPPM), T2DM-only cohorts ($1,343 PPPM) and the control ($825 PPPM). Adjusted all-cause total costs were 1.48 for T2DM-only, 1.49 for prior CV events-only and 1.93 for T2DM + prior CV events times higher compared to controls.Conclusion: In this large and geographically broad U.S based cohort, CV risk for T2DM patients was elevated, as was the risk for patients with prior CV events, while patients with T2DM + prior CV events had the highest risk of future CV events. The substantial clinical and economic burden of CV and HF in patients with both T2DM and prior CV events suggest a need for an integrated treatment and targeted intervention across both conditions.