Heart disease is the leading cause of death across all age, gender, and racial groups in the United States. According to the Centers for Disease Control and Prevention (CDC), one person dies every 37 seconds from heart disease.
Despite its prevalence in the United States, there is no national system or organization responsible for collecting data on cardiovascular disease occurrences. This means that all new and existing information about heart disease in the U.S. comes from disparate data sources—like medical claims data, electronic health record (EHR) systems, and patient surveys. The lack of organized, centralized data collection also means that tracking heart disease incidence rates in the U.S. can be difficult.
High-incidence geographic areas for aortic stenosis patients
Many healthcare industry stakeholders will use CBSA analytics when mapping heart disease patient populations. CBSAs are geographic regions that correspond to metropolitan areas of 50,000 people or fewer. Because these are smaller, more specified areas than state or regional parameters, CBSAs often provide greater insight into disease prevalence and population health.
The problem with using CBSA analytics to map heart disease, however, is that the disease is so widespread that patient data tends to mirror U.S. population data—with higher patient volumes reported in more densely populated areas.
Incorporating external sources, like U.S. Census Bureau data, adds greater nuance to search results and helps to refine patient diagnosis volumes.
For example, aortic stenosis—or a narrowing of the aortic valve—is one of the most common heart valve diseases. According to 2019 CBSA analytics, the top three metropolitan areas by aortic stenosis patient volumes are New York City, Los Angeles, and Philadelphia.
Metropolitan areas with the highest aortic stenosis patient volumes
Aortic Stenosis Total Patient Volume
New York-Newark-Jersey City NY-NJ-PA
Los Angeles-Long Beach-Anaheim CA
Fig 1 CBSA market overview from Definitive Healthcare’s Hospitals & IDNs database. Aortic stenosis total patient volumes are aggregated using all-payer medical claims data from 2019, the most recent full-year data available. Accessed June 2020.
It’s not surprising that the greatest number of aortic stenosis patients would be found in three of the top five largest cities in the U.S. But for the purposes of data collection, this trend speaks little to the specific patient populations that are impacted by this condition and where they’re located.
Aortic stenosis prevalence in the U.S.
Fig 2 Map represents aortic stenosis patient volumes by both CBSA and by patients per 1000. Aortic stenosis diagnosis data is from Definitive Healthcare’s Medical Claims database and uses all-payer medical claims data from 2019, the most recent full-year data available. Patients per 1000 was calculated using 2019 population data from the U.S. Census Bureau. Commercial claims data is sourced from multiple medical claims clearinghouses and is updated on a monthly basis. Accessed June 2020.
The map above combines aortic stenosis diagnosis volumes by CBSA with patients per 1000 to show patient “hotspots” across the U.S. Though larger circles in areas like New York City, Los Angeles, and Philadelphia represent higher patient volumes, the blue color of these circles indicates that the number of patients per 1000 people is actually lower than other areas like Portland, Maine or Moline, Illinois.
What are the most common cardiac procedures in the U.S.?
With 294,808 total procedures in 2019, “insertion of infusion device into superior vena cava, percutaneous approach” is the most common cardiac procedure in the U.S. This is primarily used to deliver intravenous medication or fluids to the heart.
All cardiac procedures have the same unique two-digit identifier in the ICD-10 procedure coding system (PCS). Using claims analytics, pharmaceutical and medical device companies can search for any ICD-10-PCS code beginning with “02” to isolate all cardiac procedures—both therapeutic and surgical.
Top 10 most common cardiac procedures by procedure volume
Total Number of Procedures
Insertion of Infusion Device into Superior Vena Cava, Percutaneous Approach
Dilation of Coronary Artery, One Artery with Drug-eluting Intraluminal Device, Percutaneous Approach
Insertion of Infusion Device into Right Atrium, Percutaneous Approach
Bypass Coronary Artery, One Artery from Left Internal Mammary, Open Approach
Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach
Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach
Bypass Coronary Artery, Two Arteries from Aorta with Autologous Venous Tissue, Open Approach
Dilation of Coronary Artery, One Artery with Two Drug-eluting Intraluminal Devices, Percutaneous Approach
Replacement of Aortic Valve with Zooplastic Tissue, Percutaneous Approach
Destruction of Conduction Mechanism, Percutaneous Approach
Fig 3 Cardiac procedure volumes are from Definitive Healthcare’s Medical Claims database and represent all ICD-10-PCS procedures beginning with “02.” Total procedure volumes reflect all-payer medical claims from 2019, the most recent full-year data available. Accessed June 2020.
Knowing which cardiac procedures are most common is a good way for pharmaceutical manufacturers and medical device companies in the heart disease space to understand treatment demand.
Identifying hospitals with high cardiac procedure volumes
With claims analytics, pharmaceutical and medical device companies can use the same search for top cardiac procedures to find high-performing hospitals. Instead of sorting the search results by ICD-10 procedure code, they can sort by provider to generate a list of facilities by cardiac procedure volume.
Let’s use another example. Drug eluting intraluminal device procedures are among the top ten most common cardiac procedures in the U.S. The procedure involves inserting a special stent into patients with coronary artery disease in order to preserve blood flow through the coronary artery. This particular stent is coated in a time-release medication that helps to slow or prevent plaque buildup in the artery.
Top 10 hospitals by total number of drug eluting intraluminal device procedures
Est. Total Number of Procedures
Mount Sinai Medical Center
North Shore University Hospital
Lenox Hill Hospital
UNC Rex Hospital
NY-Presbyterian/Weill Cornell Medical Center
Abbott Northwestern Hospital
St Francis Hospital - The Heart Center
Fig 4 Data for hospital drug-eluting intraluminal device procedures is from Definitive Healthcare’s Medical Claims database. Estimated total number of procedure volumes is based on data through Q3 of 2019. Accessed May 2020.
According to 2019 procedure estimates, Mount Sinai Medical Center in New York performed the greatest number of drug eluting intraluminal device procedures—with 1,174 reported.
In fact, half of the highest-performing hospitals on the above list are located in New York. Medical device companies who manufacture drug eluting intraluminal devices could use this information to not only refine their sales territory, but also to pinpoint specific physicians within high-performing hospitals and begin sales conversations.
How is COVID-19 impacting heart disease patients?
Respiratory infections like the flu and pneumonia are largely thought to increase the risk of heart attacks or strokes. Given this information, many health experts expected the same to hold true for a virus like COVID-19—which presents with so many respiratory symptoms. Surprisingly, many hospitals are actually reporting a 40 to 60 percent reduction in heart attack admissions.
This decrease is not, however, because people are having fewer heart attacks. The marked drop in reported cases is due to the fact that heart attack patients aren’t going to the hospital, even if they’re experiencing cardiac distress.
Many people have begun to delay or even avoid critical in-person medical care out of fear that visiting a healthcare facility might expose them to the COVID-19 virus. For heart disease patients and people with an increased risk for heart attack, this means that lifesaving treatment might come too late—or not at all.
Delaying essential care services in this way not only results in a higher mortality rate among the heart disease patient population but might also have lasting effects even as patients begin to resume their normal treatments.
Those who postponed critical care during the months of the COVID-19 pandemic might be in worse health than they were when symptoms first began, and might not respond as well to care or treatment.