Elsevier

Ophthalmology

Volume 114, Issue 12, December 2007, Pages 2174-2178
Ophthalmology

Original article
Annual Rates of Arterial Thromboembolic Events in Medicare Neovascular Age-Related Macular Degeneration Patients

Presented at: American Society of Retinal Specialists/European Society of Retinal Specialists meeting, September 2006, Cannes, France, and American Society of Retinal Specialists meeting, December 2007, Palm Springs, California.
https://doi.org/10.1016/j.ophtha.2007.09.017Get rights and content

Purpose

Smoking, age, and nutrition have been associated with the development of neovascular age-related macular degeneration (AMD) and can increase the risk of arterial thromboembolic events (ATEs). This study assesses annual rates of ATEs in new-onset neovascular AMD patients compared with matched controls.

Design

Retrospective study.

Participants

New-onset neovascular AMD patients and age-, race-, gender-, and database length–matched controls from the 5% Medicare database.

Methods

We conducted a retrospective analysis of the 5% Medicare database from 2001 to 2003. New-onset neovascular AMD patients were included if they were ≥65 years old, had 2 diagnoses of neovascular AMD, and had at least 1 year of data before the first diagnosis of AMD within the dataset. A control group was constructed in a 3:1 ratio from those without a diagnosis of a major eye disorder and matched by age, race, gender, and length of data. Annual prevalence rates were determined for myocardial infarctions (MIs) and ischemic cerebral vascular accidents (CVAs).

Main Outcome Measures

Rates of MIs and ischemic CVAs in new-onset neovascular AMD patients and matched controls from 2001 to 2003.

Results

There were 15 771 new-onset neovascular AMD patients identified and matched with 46 408 controls. Average age was 80.5 years, with 64% ≥80; 65% were female; and 95.9% were white. Inpatient MI rates for neovascular AMD patients and controls were 2.2% and 2.2%, respectively (P = 0.74). Inpatient ischemic CVA rates for neovascular AMD patients and controls were 3.5% and 3.6%, respectively (P = 0.59). Myocardial infarction rates and ischemic CVA rates for both groups increased with age. Subgroups of patients with comorbidities known to be risk factors for ATEs (i.e., hypertension, hyperlipidemia, diabetes, and arrhythmias) had a higher rate of events. Patients with previous ATEs were also at a higher risk of subsequent events, at 7.4% for inpatient MI and 35.1% for inpatient ischemic stroke.

Conclusion

Despite the shared risk factors associated with neovascular AMD and ATEs, Medicare beneficiaries with neovascular AMD had a rate of ATEs similar to that of matched controls. Rates of ATEs increased in patients with comorbidities and for patients with previous events.

Section snippets

Data Sources and Study Population

The data sources for our study were the Medicare standard analytic files for 2001 to 2003. These files contain all inpatient, outpatient, physician, and supplier claims for 5% of all Medicare beneficiaries enrolled in the fee-for-service Medicare program. The standard analytic files contain patient characteristics; details regarding hospitalizations, diagnostic testing, and therapeutic procedures; and physician services (inpatient and outpatient). Unique patient identification numbers allow

Results

During our study period, the 5% Medicare database consisted of about 2 million people with an average age of 75 years, 59% of whom were female and 86% white. Our study included 15 771 new-onset neovascular AMD patients and 46 408 controls matched by age, gender, race, and length of data within the database (Table 1). This subset was older than the overall Medicare database population, with an average age of 80.5 years, and predominantly female (65%) and white (95.9%). Over half of the patients

Discussion

In this retrospective study of a large national claims database, neovascular AMD patients did not have an increased risk of MI or ischemic CVA compared with controls. Neovascular AMD patients had higher rates of comorbidities that could have increased the risk of ATEs, including diabetes, hyperlipidemia, and hypertension. Myocardial infarction and CVA event rates for both neovascular AMD patients and controls increased with age, with the exception of one age group (65–70 years) for MI. The

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    Manuscript no. 2007-455.

    Analysis conducted by ZD Associates was supported in part by Genentech, Inc.

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