1. Chapter 4: Cardiovascular Disease in Patients With CKD 2015 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D ISEASE

2. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on 12/31/2013 with fee-for-service coverage for the entire calendar year. Totals of patients for the study cohort: N=1,238,888; With CKD=132,840; Without CKD=1,106,048. Abbreviations: AFIB, atrial fibrillation; AMI, acute myocardial infarction; ASHD, atherosclerotic heart disease; CHF, congestive heart failure; CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; CVD, cardiovascular disease; PAD, peripheral arterial disease; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; VHD, valvular heart disease. Figure 4.1 Cardiovascular disease in patients with or without CKD, 2013 Vol 1, CKD, Ch 42

3. Table 4.1 Prevalence of cardiovascular comorbidities & procedures (%), by CKD status, age, race & sex, 2013 Vol 1, CKD, Ch 43 (Continued on next slide) Overall66-6970-7475-8485+White Black/ Af Am OtherMaleFemale Cardiovascular Comorbidities 1 Atherosclerotic heart disease (ASHD) Without CKD16.510.514.620.122.917.013.3 22.012.5 Any CKD41.533.138.343.545.042.535.638.249.034.7 Acute myocardial infarction (AMI) Without CKD2.31.52.02.63.32.31.81.52.91.8 Any CKD10.18.79.510.111.110.48.87.711.98.4 Congestive heart failure (CHF) Without CKD6.43.04.37.413.86.47.65.06.66.3 Any CKD28.821.322.727.938.328.930.424.528.928.7 Valvular heart disease (VHD) Without CKD4.92.43.76.28.55.13.23.64.75.0 Any CKD13.68.410.114.018.214.210.211.113.513.7 Cerebrovascular accident/transient ischemic attack (CVA-TIA) Without CKD7.33.95.79.112.07.38.25.87.27.3 Any CKD18.413.716.119.520.918.320.216.318.618.2 Peripheral artery disease (PAD) Without CKD8.94.26.310.518.39.09.96.99.08.9 Any CKD25.819.221.826.231.526.125.522.126.924.8 Atrial fibrillation (AFIB) Without CKD9.54.06.612.118.510.14.85.110.78.6 Any CKD24.114.117.525.032.725.914.616.026.422.1 Cardiac arrest and ventricular arrhythmias (SCA/VA) Without CKD1.30.81.21.6 1.41.10.81.80.9 Any CKD4.33.94.14.74.34.44.52.85.92.9

4. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on 12/31/2013 with fee-for-service coverage for the entire calendar year. Total patients for the study cohort: N=1,238,888. Abbreviations: AFIB, atrial fibrillation; AMI, acute myocardial infarction; ASHD, atherosclerotic heart disease; Af Am, African American; CABG, coronary artery bypass grafting; CHF, congestive heart failure; CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; CVD, cardiovascular disease; ICD/CRT-D, implantable cardioverter defibrillators/cardiac resynchronization therapy with defibrillator devices; PAD, peripheral arterial disease; PCI, percutaneous coronary interventions; SCA/VA, sudden cardiac arrest and ventricular arrhythmias; VHD, valvular heart disease. 1 The denominators for overall prevalence of all cardiovascular comorbidities are 1,106,048 Medicare enrollees age 66+ without CKD and 132,840 Medicare enrollees age 66+ with any CKD. 2 The denominators for overall prevalence of PCI and CABG are 182,891 Medicare enrollees age 66+ with ASHD and without CKD and 55,108 Medicare enrollees age 66+ with ASHD and with any CKD. The denominators for overall prevalence of ICD/CRT-D is 70,766 Medicare enrollees age 66+ with CHF and without CKD and 38,256 Medicare enrollees age 66+ with CHF and with any CKD. Table 4.1 Prevalence of cardiovascular comorbidities & procedures (%), by CKD status, age, race & sex, 2013 (continued) Vol 1, CKD, Ch 44 Overall66-6970-7475-8485+White Black/ Af Am OtherMaleFemale Cardiovascular Procedures 2 Revascularization - percutaneous coronary interventions (PCI) Without CKD2.33.52.72.11.32.41.92.02.42.2 Any CKD3.65.24.33.62.53.63.2 3.73.3 Revascularization - coronary artery bypass graft (CABG) Without CKD1.11.71.41.10.31.10.80.91.40.7 Any CKD1.83.02.71.90.61.91.01.42.21.2 Implantable cardioverter defibrillators & cardiac resynchronization therapy with defibrillator (ICD/CRT-D) Without CKD0.61.0 0.60.20.60.40.50.90.3 Any CKD1.01.61.51.20.41.0 0.91.60.5

5. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on the index date, which is the date of the first condition/procedure claim, with fee-for- service coverage for the entire year prior to this date. Abbreviations: AMI, acute myocardial infarction; ASHD, atherosclerotic heart disease; CKD, chronic kidney disease. Figure 4.2 Survival of patients with a cardiovascular diagnosis or procedure, by CKD status, 2011-2013 Vol 1, CKD, Ch 45 (a) ASHD(b) AMI

6. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on the index date, which is the date of the first condition/procedure claim, with fee-for- service coverage for the entire year prior to this date. Abbreviations: CHF, congestive heart failure; CKD, chronic kidney disease; VHD, valvular heart disease. Figure 4.2 Survival of patients with a cardiovascular diagnosis or procedure, by CKD status, 2011-2013 Vol 1, CKD, Ch 46 (c) CHF(d) VHD

7. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on the index date, which is the date of the first condition/procedure claim, with fee-for- service coverage for the entire year prior to this date. Abbreviations: CKD, chronic kidney disease; CVA/TIA, cerebrovascular accident/transient ischemic attack; PAD, peripheral arterial disease. Figure 4.2 Survival of patients with a cardiovascular diagnosis or procedure, by CKD status, 2011-2013 Vol 1, CKD, Ch 47 (e) CVA/TIA(f) PAD

8. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on the index date, which is the date of the first condition/procedure claim, with fee-for- service coverage for the entire year prior to this date. Abbreviations: AFIB, atrial fibrillation; CKD, chronic kidney disease; SCA/VA, sudden cardiac arrest and ventricular arrhythmias. Figure 4.2 Survival of patients with a cardiovascular diagnosis or procedure, by CKD status, 2011-2013 Vol 1, CKD, Ch 48 (g) AFIB(h) SCA / VA

9. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on the index date, which is the date of the first condition/procedure claim, with fee-for- service coverage for the entire year prior to this date. Abbreviations: CABG, coronary artery bypass grafting; CKD, chronic kidney disease; PCI, percutaneous coronary interventions. Figure 4.2 Survival of patients with a cardiovascular diagnosis or procedure, by CKD status, 2011-2013 Vol 1, CKD, Ch 49 (i) PCI(j) CABG

10. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on the index date, which is the date of the first condition/procedure claim, with fee-for- service coverage for the entire year prior to this date. Abbreviations: CKD, chronic kidney disease; ICD/CRT-D, implantable cardioverter defibrillators/cardiac resynchronization therapy with defibrillator devices. Figure 4.2 Survival of patients with a cardiovascular diagnosis or procedure, by CKD status, 2011-2013 Vol 1, CKD, Ch 410 (k) ICD / CRT / D

11. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on 12/31/2013 with fee-for-service coverage for the entire calendar year. Total patients for the study cohort: N=97,026. Abbreviation: CKD, chronic kidney disease. Table 4.2 Characteristics of patients with heart failure, by CKD status, 2013 Vol 1, CKD, Ch 411 Systolic +/- Diastolic heart failure Diastolic only heart failureHeart failure, unspecified Without CKDAny CKD Without CKDAny CKD Without CKDAny CKD N 13,41911,33911,5849,31535,89915,470 Age (% of N): 66-6913.711.010.69.211.19.3 70-7419.516.514.914.515.714.6 75-8438.839.238.138.336.938.3 85+28.033.236.338.036.337.9 Sex (% of N) Male54.157.731.836.339.845.2 Female45.942.368.263.760.254.8 Race (% of N) White87.783.888.284.885.983.0 Black/African American 8.011.67.710.79.111.4 Other race4.34.64.14.55.15.7 Comorbidity (% of N) Non-diabetes61.643.062.744.062.344.8 Diabetes38.457.037.356.037.755.2

12. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on 12/31/2013 with fee-for-service coverage for the entire calendar year. Totals of patients for the study cohort: N=1,238,88; Without CKD=1,106,048; Any CKD=132,840; Stages 1-2=13,271; Stage 3=61,466; Stages 4-5=13,504. Abbreviations: CKD, chronic kidney disease. Figure 4.3 Heart failure in patients with or without CKD, 2013 Vol 1, CKD, Ch 412

13. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on 12/31/2011 with fee-for-service coverage for the entire calendar year. Survival is adjusted for age, sex, race, diabetic status, and hypertension status. Abbreviations: CKD, chronic kidney disease; CHF, congestive heart failure. Figure 4.4 Adjusted survival of patients by CKD and CHF status, 2012-2013 Vol 1, CKD, Ch 413

14. Data Source: Special analyses, Medicare 5 percent sample. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the U.S. on 12/31/2013 with fee-for-service coverage for the entire calendar year. Totals of patients for the study cohort: N=88,241; Stages 1-2=13,271; Stage 3=61,466; Stages 4-5=13,504. Abbreviations: AFIB, atrial fibrillation; CHF, congestive heart failure; CKD, chronic kidney disease. Table 4.3 Prevalence of AFIB by stage of CKD, age, race, sex, diabetic status, hypertension status, and CHF status, 2013 Vol 1, CKD, Ch 414 Stage of CKD Stages 1-2Stage 3Stages 4-5 AFIB (Overall)20.824.526.6 Age: 66-6911.314.716.8 70-7414.918.020.8 75-8422.625.126.6 85+31.332.9 Sex Male23.027.329.3 Female18.822.024.4 Race White22.926.329.3 Black/African American12.915.414.2 Other race11.716.118.6 Comorbidity Non-diabetes20.524.025.9 Diabetes21.125.127.3 Non-hypertension10.315.017.1 Hypertension21.725.227.0 No Heart Failure (CHF)12.514.213.5 Heart Failure (CHF)47.849.846.7