Howard C. Herrmann, MD

In the past decade, gains were seen in unstable angina, myocardial infarction, heart failure, and ischemic stroke.

Have recent efforts to improve care for people with cardiovascular disease been successful? To find out, investigators examined rates of hospitalization, mortality, and readmission during the past decade in a national cohort of more than 30 million Medicare beneficiaries, focusing on patients with unstable angina, myocardial infarction (MI), heart failure, and ischemic stroke.

Hospitalization rates declined for all four conditions across all age, gender, and racial groups, with some variation between states and hospitals. MI hospitalizations, for example, dropped from 1283 to 801 per 100,000 person-years from 1999 through 2011, an annual rate of decline of 4.6%. The adjusted rate of 30-day mortality during this period declined 29% for MI, 13% for unstable angina, 16% for heart failure, and 5% for ischemic stroke; similar double-digit declines were observed for 1-year mortality. Meanwhile, annual inflation-adjusted Medicare payments for index hospitalizations rose for all four conditions, despite a decrease in the mean length of stay. For example, payments for MI increased by $486, while stays declined by 1.2 days.

Citation(s):

Krumholz HM et al. Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke: 1999-2011. Circulation 2014 Aug 19; [e-pub ahead of print].