This post is authored by Immediate Past-President Ralph Brindis, MD, MACC.

 

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Today, the Journal of the American Medical Association (JAMA) released a study, co-authored by Harlan M. Krumholz, MD, SM, FACC, on the significant downward trend in hospitalization for Medicare beneficiaries with heart failure (HF). Since 2008, HF hospitalizations decreased by an impressive 30 percent. There has also been a 30 percent reduction in morbidity and mortality from cardiovascular disease in the last decade and acute myocardial infarction rates were down by 23 percent from 2002 to 2007. These results highlight how far we have come in cardiovascular treatment and care and open the door for future innovation.

 

Over 5.8 million Americans suffered from HF in 2006 alone, making it the number one cause of hospitalization and rehospitalization for aging adults. Additionally, we are all too familiar with the excessive amount of resources that HF eats up, pushing cost of care limits during a time when Medicare spending has run rampant.  Given these circumstances, HF is an area that greatly benefits from these and future reductions.  

However, the recent JAMA findings also point to areas that need improvement in the way of HF. The rate of hospitalization for black men declined at a lower rate than the national average and a substantial variation by state remains.  Additionally, the one-year mortality rate was only reduced slightly over the ten-year period, remaining high at 29.6 percent. This sobering statistic reminds us of how much more work needs to be done in applying our evidence-based medicine to this vulnerable cohort of patients and of the research that is still needed to alter the fairly dismal prognosis of this lethal disease.

These findings follow on the heels of an August paper in Circulation that unveiled stunning improvements in door-to-balloon (D2B) times.  The study found that D2B times were reduced by over 30 percent, from 96 minutes in 2005 to 64 minutes in 2010. The percent of patients treated within 90 minutes increased from 44 percent to 91 percent over those same years. Even more remarkably, the percent of patients treated within 75 minutes increased from 27 percent to 70 percent.

The importance of programs focused on increasing quality and decreasing health care costs is confirmed by these studies. The ACC remains dedicated to appropriate use criteria, guidelines and initiatives such as Hospital to Home (H2H) and the D2B Alliance and is leading the way to further reductions in hospitalizations and rehospitalizations across the country.  

We should all be proud to be a part of this win for our patients and the institution of cardiology!

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