Harlan M Krumholz1, Sharon-Lise T Normand2, Yun Wang2. 1. From the Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., Y.W.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N., Y.W.). harlan.krumholz@yale.edu. 2. From the Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., Y.W.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N., Y.W.).
Abstract
BACKGROUND: During the past decade, efforts focused intensely on improving the quality of care for people with, or at risk for, cardiovascular disease and stroke. We sought to quantify the changes in hospitalization rates and outcomes during this period. METHODS AND RESULTS: We used national Medicare data to identify all Fee-for-Service patients ≥65 years of age who were hospitalized with unstable angina, myocardial infarction, heart failure, ischemic stroke, and all other conditions from 1999 through 2011 (2010 for 1-year mortality). For each condition, we examined trends in adjusted rates of hospitalization per patient-year and, for each hospitalization, rates of 30-day mortality, 30-day readmission, and 1-year mortality overall and by demographic subgroups and regions. Rates of adjusted hospitalization declined for cardiovascular conditions (38.0% for 2011 compared with 1999 [95% confidence interval (CI), 37.2-38.8] for myocardial infarction, 83.8% [95% CI, 83.3-84.4] for unstable angina, 30.5% [95% CI, 29.3-31.6] for heart failure, and 33.6% [95% CI, 32.9-34.4] for ischemic stroke compared with 10.2% [95% CI, 10.1-10.2] for all other conditions). Adjusted 30-day mortality rates declined 29.4% (95% CI, 28.1-30.6) for myocardial infarction, 13.1% (95% CI, 1.1-23.7) for unstable angina, 16.4% (95% CI, 15.1-17.7) for heart failure, and 4.7% (95% CI, 3.0-6.4) for ischemic stroke. There were also reductions in rates of 1-year mortality and 30-day readmission and consistency in declines among the demographic subgroups. CONCLUSIONS: Hospitalizations for acute cardiovascular disease and stroke from 1999 through 2011 declined more rapidly than for other conditions. For these conditions, mortality and readmission outcomes improved.
BACKGROUND: During the past decade, efforts focused intensely on improving the quality of care for people with, or at risk for, cardiovascular disease and stroke. We sought to quantify the changes in hospitalization rates and outcomes during this period. METHODS AND RESULTS: We used national Medicare data to identify all Fee-for-Service patients ≥65 years of age who were hospitalized with unstable angina, myocardial infarction, heart failure, ischemic stroke, and all other conditions from 1999 through 2011 (2010 for 1-year mortality). For each condition, we examined trends in adjusted rates of hospitalization per patient-year and, for each hospitalization, rates of 30-day mortality, 30-day readmission, and 1-year mortality overall and by demographic subgroups and regions. Rates of adjusted hospitalization declined for cardiovascular conditions (38.0% for 2011 compared with 1999 [95% confidence interval (CI), 37.2-38.8] for myocardial infarction, 83.8% [95% CI, 83.3-84.4] for unstable angina, 30.5% [95% CI, 29.3-31.6] for heart failure, and 33.6% [95% CI, 32.9-34.4] for ischemic stroke compared with 10.2% [95% CI, 10.1-10.2] for all other conditions). Adjusted 30-day mortality rates declined 29.4% (95% CI, 28.1-30.6) for myocardial infarction, 13.1% (95% CI, 1.1-23.7) for unstable angina, 16.4% (95% CI, 15.1-17.7) for heart failure, and 4.7% (95% CI, 3.0-6.4) for ischemic stroke. There were also reductions in rates of 1-year mortality and 30-day readmission and consistency in declines among the demographic subgroups. CONCLUSIONS: Hospitalizations for acute cardiovascular disease and stroke from 1999 through 2011 declined more rapidly than for other conditions. For these conditions, mortality and readmission outcomes improved.
Authors: T A Marciniak; E F Ellerbeck; M J Radford; T F Kresowik; J A Gold; H M Krumholz; C I Kiefe; R M Allman; R A Vogel; S F Jencks Journal: JAMA Date: 1998-05-06 Impact factor: 56.272
Authors: Ralph L Sacco; Scott E Kasner; Joseph P Broderick; Louis R Caplan; J J Buddy Connors; Antonio Culebras; Mitchell S V Elkind; Mary G George; Allen D Hamdan; Randall T Higashida; Brian L Hoh; L Scott Janis; Carlos S Kase; Dawn O Kleindorfer; Jin-Moo Lee; Michael E Moseley; Eric D Peterson; Tanya N Turan; Amy L Valderrama; Harry V Vinters Journal: Stroke Date: 2013-05-07 Impact factor: 7.914
Authors: Rajendra H Mehta; Cecelia K Montoye; Meg Gallogly; Patricia Baker; Angela Blount; Jessica Faul; Canopy Roychoudhury; Steven Borzak; Susan Fox; Mary Franklin; Marge Freundl; Eva Kline-Rogers; Thomas LaLonde; Michele Orza; Robert Parrish; Martha Satwicz; Mary Jo Smith; Paul Sobotka; Stuart Winston; Arthur A Riba; Kim A Eagle Journal: JAMA Date: 2002-03-13 Impact factor: 56.272
Authors: Kirkwood F Adams; Gregg C Fonarow; Charles L Emerman; Thierry H LeJemtel; Maria Rosa Costanzo; William T Abraham; Robert L Berkowitz; Marie Galvao; Darlene P Horton Journal: Am Heart J Date: 2005-02 Impact factor: 4.749
Authors: Véronique L Roger; Steven J Jacobsen; Susan A Weston; Tauqir Y Goraya; Jill Killian; Guy S Reeder; Thomas E Kottke; Barbara P Yawn; Robert L Frye Journal: Ann Intern Med Date: 2002-03-05 Impact factor: 25.391
Authors: Véronique L Roger; Susan A Weston; Margaret M Redfield; Jens P Hellermann-Homan; Jill Killian; Barbara P Yawn; Steven J Jacobsen Journal: JAMA Date: 2004-07-21 Impact factor: 56.272
Authors: W D Rosamond; L E Chambless; A R Folsom; L S Cooper; D E Conwill; L Clegg; C H Wang; G Heiss Journal: N Engl J Med Date: 1998-09-24 Impact factor: 91.245
Authors: Christine Eibner; Heather Krull; Kristine M Brown; Matthew Cefalu; Andrew W Mulcahy; Michael Pollard; Kanaka Shetty; David M Adamson; Ernesto F L Amaral; Philip Armour; Trinidad Beleche; Olena Bogdan; Jaime Hastings; Kandice Kapinos; Amii Kress; Joshua Mendelsohn; Rachel Ross; Carolyn M Rutter; Robin M Weinick; Dulani Woods; Susan D Hosek; Carrie M Farmer Journal: Rand Health Q Date: 2016-05-09
Authors: Marat Fudim; Christopher M O'Connor; Allison Dunning; Andrew P Ambrosy; Paul W Armstrong; Adrian Coles; Justin A Ezekowitz; Stephen J Greene; Marco Metra; Randall C Starling; Adriaan A Voors; Adrian F Hernandez; G Michael Felker; Robert J Mentz Journal: Eur J Heart Fail Date: 2017-10-29 Impact factor: 15.534
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Ciaran N Kohli-Lynch; Brandon K Bellows; George Thanassoulis; Yiyi Zhang; Mark J Pletcher; Eric Vittinghoff; Michael J Pencina; Dhruv Kazi; Allan D Sniderman; Andrew E Moran Journal: JAMA Cardiol Date: 2019-10-01 Impact factor: 14.676