Declining Hospitalizations, Better Outcomes for Acute CVD

August 19, 2014

NEW HAVEN, CT — Hospitalizations for acute cardiovascular conditions, including MI and unstable angina, declined significantly over a recent 12-year period, according to a new analysis of Medicare beneficiaries[1].

Compared with hospitalizations in 1999, the 2011 adjusted rate of hospitalization for MI declined 38%, while the rate of hospitalizations for unstable angina declined nearly 84%. For heart failure and ischemic stroke, the adjusted rate of hospitalizations declined 30.5% and 33.6%, respectively.

In contrast, other clinical conditions, including pneumonia and chronic obstructive bronchitis, declined just 10.2% over the same time period.

"This study reveals an era in the history of cardiovascular disease that was characterized by improvements in the rates of hospitalization and outcomes of four major cardiovascular conditions, with particular gains for MI and unstable angina," write Dr Harlan Krumholz (Yale University School of Medicine, New Haven, CT) and colleagues August 18, 2014 in Circulation. "The improvement in rates of hospitalization is far greater than that achieved for other causes of hospitalizations."

Importantly, the researchers also observed significant reductions in the adjusted 30-day mortality rates among those hospitalized with MI, unstable angina, heart failure, and stroke. Compared with 1999, the 2011 30-day mortality rates declined 29.4%, 13.1%, 16.4%, and 4.7%, respectively. One-year mortality rates and 30-day readmission rates also significantly declined. The reductions were observed across different US regions and in multiple subgroups. They do note, though, that improvements were not documented in every US state, suggesting there is still work to be done.

The researchers speculate that improvements in the identification of hypertension, better use of statin therapy, declines in smoking rates, improvements in the use of evidence-based medicine, and more timely treatment of STEMI might be some of the reasons for reductions in hospitalizations of these acute cardiovascular conditions.

American College of Cardiology (ACC) president Dr Patrick O'Gara (Brigham and Women's Hospital, Boston, MA) released a statement following the publication of the Krumholz et al analysis, saying the continued reduction in hospitalization and mortality rates from 1999 to 2011 occurred without the introduction of any new practice-changing drug or biological treatments for cardiovascular disease or stroke. "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," states O'Gara. "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."

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