Heart-Related Mortality and Hospitalizations on the Decline Since 1999

Hospitalization rates for heart disease and stroke have dropped significantly over the past decade.

Hospitalizations and deaths related to heart disease and stroke have dropped since the turn of the millennium, according to a report published online August 18, 2014, in Circulation.

For their report, researchers from the Yale School of Medicine examined Medicare Fee-For-Service patients from January 1, 1999, through December 31, 2011, totaling nearly 34 million cases. All patients were aged 65 years or older and had been hospitalized with unstable angina, myocardial infarction (MI), heart failure (HF), ischemic stroke, and any other conditions during the time period.

Aside from demographic factors, the researchers collected data on hospitalization and whether the patient died within a month of hospitalization, was admitted again within a month, or died during the following year.

“We were interested in what had been achieved over the last decade, particularly given that the period was marked by intense activities focused on improving the quality of cardiovascular and stroke care, and substantial efforts to promote healthier behaviors,” Harlan Krumholz, MD, MS, director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital, told Pharmacy Times. “True accountability for our efforts requires that we not settle for knowing how many programs and initiatives we have launched, but how many lives have been positively affected. The question was: what have we achieved?”

Between 1999 and 2011, hospitalization rates dropped:

• 38% for heart attack
• 83.8% for unstable angina, which often leads to heart attack
• 30.5% for HF
• 33.6% for ischemic stroke

Additionally, the risk of mortality within a year of release decreased:

• 21% for unstable angina
• 23% for heart attacks
• 13% for HF and stroke

“We were surprised by how much progress had been made so quickly,” Harlan said of the findings. “We expected progress, as there is evidence that in this period, we have done more with the knowledge we have…but these results are stunning.”

In 1999, the top 5 conditions other than MI, unstable angina, HF, and stroke were other forms of chronic ischemic heart disease (6.5%), pneumonia (6.2%), cardian dysrhythmias (4.2%), chronic bronchitis (3.8%), and disorders of electrolyte and acid-base balance (2.9%). Contrastingly, by 2011, the top 5 conditions other than MI, HF, and stroke were pneumonia (4.4%), unspecified septicemia (3.9%), acute cystitis (2.9%), obstructive chronic bronchitis with acute exacerbation (2.9%), and unspecified acute kidney failure (2.7%).

“Our attention to improving our performance is paying off, (as) we are making real progress for patients, saving lives, and averting adverse health events,” Harlan said when asked what health care professionals can take away from the study. “We cannot be complacent—or celebrate too long–but it is worth a brief pause to realize we are on the right track. And then, we must redouble our efforts to replicate this result in the next decade.”