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Trends in Hospitalizations and Outcomes for Acute Cardiovascular Disease and Stroke: 1999-2011
Study Questions:
What are the changes in hospitalization rates and outcomes for cardiovascular diseases during the last decade?
Methods:
The investigators used national Medicare data to identify all fee-for-service patients ages ≥65 years hospitalized with unstable angina, myocardial infarction, heart failure, ischemic stroke, and all other conditions from 1999 through 2011 (2010 for 1-year mortality). For each condition, they examined trends in adjusted rates of hospitalization per patient-year and, for each hospitalization, rates of 30-day mortality, 30-day readmission, and 1-year mortality overall and by demographic subgroups and regions. The authors fitted a generalized linear mixed-effects model with a Poisson link function, adjusting for age, sex, and race, to evaluate temporal change in the rates of hospitalization, and computed incidence rate ratios to summarize changes.
Results:
Rates of adjusted hospitalization declined for cardiovascular conditions (38.0% for 2011 compared with 1999 [95% confidence interval] [37.2-38.8%] for myocardial infarction; 83.8% [83.3-84.4%] for unstable angina; 30.5% [29.3-31.6%] for heart failure; and 33.6% [32.9-34.4%] for ischemic stroke compared with 10.2% [10.1-10.2%] for all other conditions). Adjusted 30-day mortality rates declined 29.4% [28.1-30.6%] for myocardial infarction; 13.1% [1.1-23.7%] for unstable angina; 16.4% [15.1-17.7%] for heart failure; and 4.7% for ischemic stroke [3.0-6.4%]. There were also reductions in rates of 1-year mortality and 30-day readmission and consistency in declines among the demographic subgroups.
Conclusions:
The authors concluded that hospitalizations for acute cardiovascular disease and stroke from 1999 through 2011 declined more rapidly than for other conditions.
Perspective:
This study reports that the past decade was characterized by improvements in the rates of hospitalization and outcomes of four major cardiovascular conditions, with particular gains for myocardial infarction and unstable angina. This improvement in rates of hospitalization is far greater than that achieved for other causes of hospitalization. Importantly, the declines and improvements in cardiovascular conditions and stroke were not associated with increases in hospitalizations for other conditions, and the improvements occurred across demographic groups. The next step is to understand the key determinants of this result, continue the positive trends, and remove cardiovascular disease and stroke from among the top causes of disease and disability.
Keywords: Myocardial Infarction, Stroke, Heart Failure, Medicare, Hospitalization
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