‘Striking’ Improvements in Acute MI Care Over Past 20 Years, Report Shows

There has been a marked reduction in the number of patients hospitalized for acute myocardial infarction, as well as significant improvements in short- and midterm clinical outcomes, over the past 20 years, according to a new analysis of Medicare fee-for-service patients.

Over a recent two-decade span, there were significant declines in the number of patients hospitalized for acute MI and reductions in 30-day rates of mortality and all-cause readmissions among these patients. The 30-day mortality rate declined from 20.0% in 1995 to 12.4% in 2014, while readmissions at 30 days declined from 21.0% to 15.3% during the same period.

“The results are striking [and] the outcomes from the patient perspective are a home run,” lead investigator Harlan Krumholz, MD (Yale School of Medicine, New Haven, CT), told TCTMD in an email. “We dropped hospitalization rates by a third, even as our tests for acute MI became more sensitive. This drop is not a mere statistic—so many people and their families and others who care about them avoided catastrophic events and suffering—and the system also saved enormous sums of dollars and resources.”

Published March 15, 2019, in JAMA Network Open, the analysis includes 4,367,485 Medicare fee-for-service patients ages 65 years or older who were hospitalized for acute MI between 1995 and 2014. Krumholz said the study is a comprehensive assessment of acute MI hospitalizations and outcomes during a period when the healthcare community focused on improving quality of care for risk factor modification and therapy.  

“At the beginning of this period we had many effective tools, but they were being inconsistently, and even ineffectively, applied,” said Krumholz. “This 20-year period was about the ‘how’ of acute MI prevention and care—how to apply what we knew, [or] the implementation science of healthcare.”

Between 1995 and 2014, the length of hospital stay declined, as did the risk of recurrent MI at 1 year. In terms of demographics, the percentage of female patients hospitalized for acute MI declined, as did the percentage of white patients. In contrast, the percentage of black acute MI patients increased. The average age of patients hospitalized for acute MI is higher today than it was 20 years ago, increasing from 76.9 years in 1995 to 78.2 years in 2014, which suggests progress in delaying the onset of acute MI, say researchers.

Regarding procedures, there has been an increase in the use of coronary catheterization and PCI, but a reduction in the rate of coronary artery bypass graft surgery. There was also an increase in the Medicare inpatient payment per acute MI, up from $9,282 in 1995 to $11,031 in 2014. “The costs of hospitalizations and use of procedures increased, but the big picture was a huge improvement in outcomes and a huge decrease in overall costs associated with acute MI,” said Krumholz.

Despite the success, he added that the community should not become complacent given that there is work to do still. Also, there are threats to the progress, with rising rates of diabetes and obesity. Nonetheless, Krumholz said the new report documents an “amazing era where breakthroughs were translated into routine practice and improvements were achieved.”