Journal Wrap

The hottest research from various peer-reviewed journals – handpicked weekly by the Editorial Board led by Kim Eagle, MD, MACC.

Study Sheds New Light On Factors Associated With Variation in Hospital Payments

Findings from a study published in JAMA Open Network suggest "that variation in payments to hospitals are, at least in part, associated with the hospitals and their ecosystems independently" of other social determinants (i.e., behaviors, race and ethnicity).

Harlan M. Krumholz, MD, SM, FACC, et al., looked at 1,615 Medicare beneficiaries hospitalized with heart failure (HF) and 708 beneficiaries hospitalized with pneumonia ages 65 years and older.

Researchers looked at two payment measure cohorts: hospitals that were classified into payment quartiles for HF and pneumonia, and patients with two admissions for HF or pneumonia – one in a lowest-quartile hospital and one in a highest-quartile hospital more than one month apart.


Results showed that the same Medicare beneficiaries who were admitted with the same diagnosis (HF or pneumonia) to hospitals with the highest payment profiles incurred higher costs than when they were admitted to hospitals with the lowest payment profiles.

Krumholz, et al. noted that the 30-day episode payment for hospitalization for the same patients at the lowest payment hospitals was $2,118 lower for HF and $2,907 lower for pneumonia than at the highest-payment hospitals, and more than half of the difference was associated with the payment during the index hospitalization for HF and pneumonia.

Results also revealed that the 30-day mortality rates for patients in low-payment hospitals vs. patients in high-payment hospitals were not significantly different for HF or pneumonia, nor were median length of stay and readmission rate.

No significant difference was observed in mean days between the paired admissions among patients first admitted to the low-payment hospitals and among patients first admitted to the high-payment hospitals.

"Research is needed to identify and address cultural and financial factors in resource use that might affect these different payment profiles," Krumholz and colleagues write. "Nevertheless, the idea that lower costs are achievable may provide the impetus to investigate new strategies rather than simply resist the possibility that efficiencies can be achieved."

Krumholz HM, Wang Y, Wang K, et al. JAMA Netw Open 2019;2:e1915604.


Treat Stroke to Target Trial: Lower Risk of CV Events With Lower LDL-C Levels

In patients with a recent ischemic stroke or transient ischemic attack (TIA) with evidence of atherosclerotic disease, having a lower LDL-C level of <70 mg/dL "had a lower risk of a composite endpoint of major cardiovascular events" vs. higher LDL-C levels, according to results of the Treat Stroke to Target trial published in the New England Journal of Medicine.

Pierre Amarenco, MD, et al., assessed 2,860 patients at 77 sites in France and South Korea who had an ischemic stroke in the previous three months or a TIA within the previous 15 days. All patients received a statin with or without ezetimibe. Patients were randomly assigned to a low-target group with a target of LDL-C <70 mg/dL vs. a high-target group with a target LDL-C from 90-110 mg/dL and were followed for a median of 3.5 years.


Results showed the primary endpoint of a composite of major cardiovascular events – ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization or death from cardiovascular cases – occurred in 121 patients in the low-target group vs. 156 in the high-target group.

However, the investigators note the trial was stopped early after 277 of 385 anticipated endpoint events occurred.

The researchers conclude that patients with a lower target LDL-C level had "a lower risk of subsequent cardiovascular events" than those with a higher target LDL-C level.

In a related editorial comment, Lawrence R., Wechsler MD, notes, "the trial provides evidence to support the original concept of statins as an agent to reduce cardiovascular risk, primarily by reducing cholesterol levels." He adds that the question of whether LDL-C is the "only and best target to reach this goal" should be further explored "to fine-tune our approach in terms of risks and benefits."

Amarenco P, Kim JS, Labreuche J, et al. N Eng J Med 2020;382:9-19.


Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Heart Failure and Cardiomyopathies, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Acute Heart Failure

Keywords: ACC Publications, Cardiology Magazine, Ischemic Attack, Transient, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medicare, Child, Preschool, Patient Readmission, Cholesterol, LDL, Ethnic Groups, Ecosystem, Length of Stay, Stroke, Brain Ischemia, Cardiovascular Diseases, Goals, Social Determinants of Health, Risk Factors, Heart Failure, Hospitalization, Hospitals, Pneumonia, Myocardial Infarction, Risk Assessment

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