Association between Cardiovascular Health Status and Health Care Utilization in a Large Integrated Health Care System

Introduction The American Heart Association (AHA) “Life's Simple 7” schema can be used to categorize patients’ cardiovascular health (CVH) status as Poor, Intermediate or Ideal based on smoking, body mass index (BMI), physical activity, dietary patterns, blood pressure, cholesterol, and fasting blood sugar. This study examined the association between CVH status and subsequent healthcare utilization. Methods This was an observational cohort study of adults from an integrated health care delivery system – Kaiser Permanente Northern California – that had outpatient care between 2013-2014. Patients were categorized by AHA CVH status: Poor, Intermediate or Ideal. Individual-level health care utilization and costs in 2015 were accumulated for each patient and compared across the 3 CVH categories and stratified by age groups. Results 991,698 patients were included in the study. 194,003 (19.6%) were age 18-39, 554,129 (55.9%) age 40-64, and 243,566 (24.6%) age ≥65 years. 259,931 (26.2%) had Ideal CVH, 521,580 (52.6%) had Intermediate CVH, and 210,187 (21.2%) had Poor CVH. Healthcare utilization measured by average relative cost per patient increased monotonically across age categories (p<0.001). In addition, CVH category was inversely associated with lower cost in each age group (p<0.001). Conclusion Adults who were younger and had more ideal CVH had relatively lower health care costs across age groups. Interventions to promote better CVH may improve patient outcomes and reduce overall healthcare expenditures.