In the Journals

Study highlights sharp decline in hospitalizations for stroke, acute CVD from 1999 to 2011

Rates of hospitalization and mortality for CV-related conditions improved significantly between 1999 and 2011, according to new data in Circulation.

While hospitalization rates decreased for all conditions from 1999 to 2011, the decrease observed for CV conditions was more pronounced than that for hospitalizations due to any other cause, Harlan Krumholz, MD, and colleagues reported.

“Interestingly, these improvements happened in a period when there were no real ‘miracle’ clinical advancements,” Krumholz, director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, said in a press release. “Rather, we saw consistent improvements in the use of evidence-based treatments and medications and an increase in quality improvement initiatives … as well as a strong emphasis on heart-healthy lifestyles and behaviors.”

Harlan Krumholz, MD

Harlan Krumholz

The researchers evaluated national Medicare data on fee-for-service plan beneficiaries aged 65 years and older who were hospitalized for CV-related conditions, including MI, HF, ischemic stroke and unstable angina, from 1999 to 2011. Readmission rates at 30 days, as well as mortality rates at 30 days and 1 year, were assessed for this cohort and compared with fee-for-service beneficiaries discharged from acute care hospitals with other diagnoses.

During the study period, 5,895,686 patients were hospitalized for HF, 3,726,488 for ischemic stroke, 3,267,884 for MI and 314,875 for unstable angina compared with 68,178,855 patients hospitalized for other conditions.

Hospitalization rates decreased significantly for all conditions during the study period, regardless of patient age, sex or race. Compared with 1999, adjusted hospitalization rates had declined for all evaluated CV conditions by 2011, including an 83.8% reduction in unstable angina, 38% reduction in MI, 33.6% reduction in ischemic stroke and 30.5% reduction in HF. These declines were observed nationwide, although the researchers noted some geographic variation.

In comparison, hospitalization for all other conditions decreased by 10.2% from 1999 to 2011.

Adjusted rates of readmission at 30 days were also decreased by 32.3% for unstable angina, 18.6% for MI, 9.7% for HF and 5.9% for ischemic stroke. The researchers noted variation in the degree of decline according to demographic subgroups.

When Krumholz and colleagues evaluated adjusted 30-day mortality rates, they found a 29.4% decline for MI, 16.4% decline for HF, 13.1% decline for unstable angina and 4.7% decline for ischemic stroke. One-year mortality rates followed a similar pattern: 23.4% decline for MI, 21.1% decline for unstable angina, 13.1% decline for ischemic stroke and 13% decline for HF.

“Huge strides in lifestyle, quality of care and prevention strategies for CV health have seemed to have a ripple effect on saving lives,” Krumholz said. “… There is still more work to do as heart disease and stroke combined remain the leading cause of death and disability, but this study documents astonishing progress and national achievement.”

Disclosure: Krumholz reports receiving research grants from Johnson & Johnson and Medtronic, through Yale University, to develop methods of clinical trial data sharing and serving as chair of a cardiac scientific advisory board for UnitedHealth; he also reports working under contract to the CMS to develop and maintain performance measures.

Rates of hospitalization and mortality for CV-related conditions improved significantly between 1999 and 2011, according to new data in Circulation.

While hospitalization rates decreased for all conditions from 1999 to 2011, the decrease observed for CV conditions was more pronounced than that for hospitalizations due to any other cause, Harlan Krumholz, MD, and colleagues reported.

“Interestingly, these improvements happened in a period when there were no real ‘miracle’ clinical advancements,” Krumholz, director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, said in a press release. “Rather, we saw consistent improvements in the use of evidence-based treatments and medications and an increase in quality improvement initiatives … as well as a strong emphasis on heart-healthy lifestyles and behaviors.”

Harlan Krumholz, MD

Harlan Krumholz

The researchers evaluated national Medicare data on fee-for-service plan beneficiaries aged 65 years and older who were hospitalized for CV-related conditions, including MI, HF, ischemic stroke and unstable angina, from 1999 to 2011. Readmission rates at 30 days, as well as mortality rates at 30 days and 1 year, were assessed for this cohort and compared with fee-for-service beneficiaries discharged from acute care hospitals with other diagnoses.

During the study period, 5,895,686 patients were hospitalized for HF, 3,726,488 for ischemic stroke, 3,267,884 for MI and 314,875 for unstable angina compared with 68,178,855 patients hospitalized for other conditions.

Hospitalization rates decreased significantly for all conditions during the study period, regardless of patient age, sex or race. Compared with 1999, adjusted hospitalization rates had declined for all evaluated CV conditions by 2011, including an 83.8% reduction in unstable angina, 38% reduction in MI, 33.6% reduction in ischemic stroke and 30.5% reduction in HF. These declines were observed nationwide, although the researchers noted some geographic variation.

In comparison, hospitalization for all other conditions decreased by 10.2% from 1999 to 2011.

Adjusted rates of readmission at 30 days were also decreased by 32.3% for unstable angina, 18.6% for MI, 9.7% for HF and 5.9% for ischemic stroke. The researchers noted variation in the degree of decline according to demographic subgroups.

When Krumholz and colleagues evaluated adjusted 30-day mortality rates, they found a 29.4% decline for MI, 16.4% decline for HF, 13.1% decline for unstable angina and 4.7% decline for ischemic stroke. One-year mortality rates followed a similar pattern: 23.4% decline for MI, 21.1% decline for unstable angina, 13.1% decline for ischemic stroke and 13% decline for HF.

“Huge strides in lifestyle, quality of care and prevention strategies for CV health have seemed to have a ripple effect on saving lives,” Krumholz said. “… There is still more work to do as heart disease and stroke combined remain the leading cause of death and disability, but this study documents astonishing progress and national achievement.”

Disclosure: Krumholz reports receiving research grants from Johnson & Johnson and Medtronic, through Yale University, to develop methods of clinical trial data sharing and serving as chair of a cardiac scientific advisory board for UnitedHealth; he also reports working under contract to the CMS to develop and maintain performance measures.

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