Outlook for Avoiding or Surviving Acute CVD, Stroke Much Improved Over Past Decade

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 Hospitalization and mortality rates for acute cardiovascular disease (CVD) and stroke decreased substantially over a recent 12-year period—and more than for other medical conditions—according to a study using Medicare data published online August 18, 2014, ahead of print in Circulation. According to the authors, the declines likely reflect increasing focus on heart-healthy lifestyles and improvements in quality CVD care. 

Methods
Researchers led by Harlan M. Krumholz, MD, SM, of Yale University School of Medicine (New Haven, CN), analyzed Medicare data on nearly 34 million patients (363,261,068 person-years) hospitalized with unstable angina, MI, CHF, ischemic stroke, or other acute CVD conditions between 1999 and 2011. This cohort was compared with approximately 68 million Medicare patients hospitalized for all other medical conditions during the same period. The percentage of acute CVD patients with vs without comorbidities increased over time.

 

Analysis showed reductions in adjusted rates of hospitalization and 30-day mortality for all CVD and stroke diagnoses as well as for other conditions (table 1).

Table 1. Estimated Declines in Adverse Outcomes by Diagnosis, 1999 to 2011

 

Hospitalization

30-Day Mortality

MI

-38.0%

-29.4%

Unstable Angina

-83.8%

-13.1%

CHF

-30.5%

-16.4%

Ischemic Stroke

-33.6%

-4.7%

All Other Conditions

-10.2%

 

The pattern of declines did not change substantially after accounting for patient characteristics and geographical differences.

Adjusted 1-year mortality rates also declined, by 23.4% for MI, 21.1% for unstable angina, 13.0% for CHF, and 13.1% for ischemic stroke. Mean length of stay and 30-day readmission rates also decreased for all CVD categories, although variations were seen across states and hospitals.

Likely Reasons for Improvement

“These are stunning results,” Dr. Krumholz said in an email with TCTMD. “With regard to hospitalizations, it is likely due to healthier behaviors and better medical care. The focus on heart-healthy lifestyle may be having an effect now, and we are more conscientious about screening and helping high-risk patients lower their risk.” For mortality, he added, the reductions are more likely related to specific improvements in quality of care. 

The paper notes that the decrease in hospitalization for CVD was not offset by hospitalization for other conditions, indicating that there was a net positive effect. 

It also acknowledges that changes in coding practices over the study period could have skewed the results—for example, if there were greater numbers of patients being coded as having MI when they actually had unstable angina, this might lead to the mistaken observation of better survival. But the researchers call this possibility “implausible” given the large declines over time.

“The greatest improvements were for the conditions where we have the most evidence for beneficial interventions, and during this period we worked to see them applied,” Dr. Krumholz said. “All of this came together for MI results.” The lesser reductions in stroke hospitalization and mortality are due to the lack of effective treatments for the vast majority of these patients, he added.

“According to recent studies, there are some areas in which we can still improve, so we should not become complacent,” Dr. Krumholz cautioned.

 


Source: 
Krumholz HM, Normand S-LT, Wang Y. Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke: 1999-2011. Circulation. 2014;Epub ahead of print.

 

 

 

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Outlook for Avoiding or Surviving Acute CVD, Stroke Much Improved Over Past Decade

Disclosures
  • Dr. Krumholz reports receiving research support from Johnson & Johnson and Medtronic, serving as chair of the cardiac scientific advisory board for UnitedHealth, and working under contract to the Centers for Medicare and Medicaid Services.

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