As noted in previous studies, patients eligible for Medicare in the U.S. have the option to choose health insurance administered by commercial health insurers through Medicare Advantage or remain on the traditional, government-administered Medicare. To better understand whether there are differences in health outcomes between patients on Medicare Advantage (MA) and traditional Medicare (TM), we compared the rates of stroke and transient ischemic attack (TIA) in congestive heart failure patients covered by MA or TM.
Stroke and TIA are considered potential complications of congestive heart failure (CHF).1 Patients diagnosed with CHF are at an increased risk of stroke or TIA—as much as 10 times the risk of the general population.2 We studied 116,352 CHF patients with MA coverage and 349,056 CHF patients with TM coverage. All patients studied were initially diagnosed with CHF after starting their Medicare coverage. We evaluated the rate of stroke and TIA for both populations for as long as they retained that coverage type, up to 10 years after initial CHF diagnosis. We found that the rates of stroke and TIA at 10 years were similar for both MA and TM patients, as shown in Figure 1. Within 10 years after initial CHF diagnosis, 22.7% of patients with MA and 21.5% of patients with TM were diagnosed with a stroke. Rates of TIA were lower—11.1% of patients with TM and 11.4% of patients with MA were diagnosed with a TIA within the 10 years following their CHF diagnosis.
To further investigate these findings, we used a Cox proportional hazards model that adjusted for race and ethnicity, sex, rurality, social vulnerability, comorbidities, and whether the patient was prescribed cardiovascular medications. The model similarly found no statistically significant difference in risk of stroke or TIA for patients on MA or TM.
