Heart-related hospitalizations, deaths reduced due to coordinated care efforts

Over the last decade there has been positive progress in reducing hospitalizations for heart attacks, heart failure and stroke, and in reducing the risk of death for the declining numbers of people who are hospitalized with those conditions, according to a study published August 18 online in Circulation.

Yale School of Medicine researcher Harlan Krumholz, MD, and colleagues studied data on nearly 34 million Medicare fee-for-service (FFS) patients aged ≥65 years hospitalized with unstable angina, myocardial infarction, heart failure, ischemic stroke, and all other conditions from 1999 through 2011 (2010 for 1-year mortality).  The researchers examined data for trends in hospitalization, dying within a month of being admitted, being admitted again within a month, and dying during the following year. The team also factored in age, sex, race, other illnesses, and geography.

By the end of 2011, hospitalization rates among all races and areas dropped 38% for heart attack; 83.8% for unstable angina, sudden chest pain often leading to heart attack; 30.5% for heart failure; and 33.6% for ischemic stroke.

Dr Krumholz and colleagues also found that risks of dying for people hospitalized within a year decreased about 21% for unstable angina, 23% for heart attacks, and 13% for heart failure and stroke.

Improved lifestyle, quality of care, and prevention strategies contributed to the decrease, according to the authors. They also noted improvements in identifying and treating high blood pressure, a rapid rise in the use of statins, marked declines in smoking, and more timely and appropriate treatment for heart attack patients as contributing to the declines in deaths and hospitalizations.

“The take away is that what we’ve been doing to try to make progress against heart disease and stroke is working,” said Dr Krumholz, director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, and national American Heart Association volunteer.

“We have much work yet to do but this is indicating that the investments we are making in the programs we are instituting are making a difference across the country and in all patient groups,” he said. “Rapid results can be achieved through the coordinated efforts of many dedicated people who are working to ensure that we are making best use of the medical knowledge we have.

“What is truly remarkable is that this progress occurred during a period where there were no new breakthrough medications or vaccines,” Dr Krumholz contined. “These gains were accomplished during a period where we, as a cardiovascular community, heavily invested in the promotion of healthy lifestyle behaviors as well as committed to improving the quality of care throughout the country. This is the evidence that that effort to make better use of the knowledge we had has paid off.”

By working together in improving systems and collaborating with the public great gains can be made, according to Dr Krumholz.

“The imperative is for us to make better use of the knowledge we have even as we continue to seek new treatments and cures,” he said. “The ordinary work of finding ways to promote healthy behaviors and strengthen the performance of our healthcare systems can pay remarkable dividends in terms of lives saved and adverse health events averted.”

In healthcare it is increasingly important that we be accountable for the results we are achieving, he explained.

“The study was conducted to provide a thorough and objective assessment of what is being achieved on behalf of patients at risk for or with cardiovascular disease and stroke,” Dr Krumholz said. “It was also done in recognition of the fact that much effort is input into improving our performance in these areas over the last decade. No area of medicine has received such attention. The cardiovascular community has generated substantial evidence in this decade marked focused efforts to ensure that that evidence was being used optimally for the benefit of patients. The study was conducted to see whether benefits of this approach can be measured in terms of what happened to patients, or what actually did not happen, to patients.”