Compared to other cardiac-related conditions, hospitalizations for acute cardiovascular disease and stroke showed rapid decline from 1999 through 2011, according to a new study published Aug. 18 in Circulation, with patients achieving improved mortality and readmission outcomes. Led by Harlan Krumholz, MD, SM, FACC, Department of Internal, Yale University School of Medicine, the new investigation sought to provide a contemporary and comprehensive national perspective on the trends for the most common cardiovascular and stroke conditions, improving on past reports that focused on specific communities, populations or conditions, did not assess the conditions as a whole and did not compare demographic and geographic differences.

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Using national Medicare data to identify all Fee-For-Service patients aged 65 years or older hospitalized with unstable angina, myocardial infarction, heart failure, ischemic stroke, and all other conditions, Krumholz and his co-authors identified 409,591,889 observations, representing 33,952,331 individual Medicare beneficiaries who contributed to a total of 363,261,068 person-years. They examined trends in adjusted rates of hospitalization per patient-year and, for each hospitalization, rates of 30-day mortality, 30-day readmission, and one-year mortality overall by demographic subgroups and regions.

Results showed the observed rates of hospitalization "declined significantly for all targeted conditions across all age and gender-race groups." Further, adjusted hospitalization rates declined (38 percent for 2011 compared to 1999 [95 percent CI][37.2 percent to 38.8 percent] for myocardial infarction; 83.8 percent [83.3 percent to 84.4 percent] for unstable angina; 30.5 percent [29.3 percent to 31.6 percent] for heart failure; and 33.6 percent [32.9 percent to 34.4 percent] for ischemic stroke compared with 10.2 percent [10.1 percent to 10.2 percent] for all other conditions).

The data also showed that 30-day mortality rates declined 29.4 percent [28.1 percent to 30.6 percent] for myocardial infarction; 13.1 percent [1.1 percent to 23.7 percent] for unstable angina; 16.4 percent [15.1 percent to 17.7 percent] for heart failure; and 4.7 percent for ischemic stroke [3.0 percent to 6.4 percent]. Reduction rates additionally occurred in one-year mortality and 30-day readmission, with consistent declines among demographic subgroups.

As evident from their findings, the authors note that the past decade has achieved a number of major therapeutic advances in cardiovascular disease and stroke that apply to large numbers of patients, health care professional and organizations, all while improving the quality of care and ensuring the appropriate application of proven interventions. Concurrent improvements have included the identification and treatment of hypertension, a significant rise in the use of statins, and declines in smoking. Improvements have also been made in the use of evidence-based medications the quick timeliness of treating patients with St-segment elevation myocardial infarction. Additional factors also include the use of registries and other data to track performance and support improvement efforts.

Concluding their report, Krumholz and his colleagues ultimately write, "Our efforts in medicine should be measured against what is actually accomplished for patients. This study documents the deaths that were averted, the hospitalizations and events that were avoided, and costs that were saved as a result of the improvements. The challenge ahead 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."

“This study confirms that in the past decade hospitalization and death rates for heart disease and stroke have continue their significant declines despite the lack of any new practice-changing drug or biological treatments introduced over this same time period,” said ACC President Patrick T. O’Gara, MD, FACC. “These declines coincide with rapid changes in attitudes about lifestyle, diet, exercise and smoking, at a time when cardiovascular medicine is leading the way in supporting evidence-based care through the use of data registries. Our goal is to see that these trends continue by encouraging healthy lifestyles and also by our support of performance measures for the entire cardiovascular team.”

Keywords: Registries, Myocardial Infarction, Stroke, Life Style, Demography, Heart Failure, Diet, Medicare, Hospitalization, Hypertension, Smoking

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