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. 2014 Sep 16;130(12):966-75.
doi: 10.1161/CIRCULATIONAHA.113.007787. Epub 2014 Aug 18.

Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, 1999-2011

Harlan M Krumholz  1 , Sharon-Lise T Normand  2 , Yun Wang  2
Affiliations

Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, 1999-2011

Harlan M Krumholz et al. Circulation. .

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.

Keywords: heart diseases; patient outcome assessment; patient readmission; stroke; trends.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Krumholz discloses that he is the recipient of research grants from Medtronic and from Johnson & Johnson, through Yale University, to develop methods of clinical trial data sharing and is chair of a cardiac scientific advisory board for UnitedHealth. Drs. Krumholz and Normand disclose that they work under contract to the Centers for Medicare & Medicaid Services to develop and maintain performance measures.

Figures

Figure 1
Figure 1
Adjusted changes in outcomes between 2011 and 1999 (2010 for 1-year mortality).
Figure 2
Figure 2
A. Maps of trends in observed rates (per 100,000 person-years) of hospitalization for myocardial infarction (top panel) and unstable angina (bottom panel) conditions (1999 to 2011) at the county level. In 1999, the myocardial infarction hospitalization rate varied from lowest counties (green, 0–534) to highest counties (red, 1607–1793) and the unstable angina hospitalization rate varied from lowest counties (green, 0–12) to highest counties (red, 795–1843). For Puerto Rico, the mean (SD) hospitalization rates for myocardial infarction declined from 9 (7.7) in 1999 to 5 (5.3) in 2011 and from 24 (1.4) in 1999 to 16 (8.0) in 2011 for unstable angina. B. Maps of trends in observed rates (per 100,000 person-years) of hospitalization for heart failure (top panel) and ischemic stroke (bottom panel) conditions (1999 to 2011) at the county level. In 1999, the heart failure hospitalization rate varied from lowest counties (green, 0–860) to highest counties (red, 2884–3259) and the unstable angina hospitalization rate varied from lowest counties (green, 0–682) to highest counties (red, 1830–2059). For Puerto Rico, the mean (SD) hospitalization rates declined for heart failure from 11 (6.2) in 1999 to 2 (1.2) in 2011 and from 11 (6.5) in 1999 to 2 (2.8) in 2011 for ischemic stroke.
Figure 2
Figure 2
A. Maps of trends in observed rates (per 100,000 person-years) of hospitalization for myocardial infarction (top panel) and unstable angina (bottom panel) conditions (1999 to 2011) at the county level. In 1999, the myocardial infarction hospitalization rate varied from lowest counties (green, 0–534) to highest counties (red, 1607–1793) and the unstable angina hospitalization rate varied from lowest counties (green, 0–12) to highest counties (red, 795–1843). For Puerto Rico, the mean (SD) hospitalization rates for myocardial infarction declined from 9 (7.7) in 1999 to 5 (5.3) in 2011 and from 24 (1.4) in 1999 to 16 (8.0) in 2011 for unstable angina. B. Maps of trends in observed rates (per 100,000 person-years) of hospitalization for heart failure (top panel) and ischemic stroke (bottom panel) conditions (1999 to 2011) at the county level. In 1999, the heart failure hospitalization rate varied from lowest counties (green, 0–860) to highest counties (red, 2884–3259) and the unstable angina hospitalization rate varied from lowest counties (green, 0–682) to highest counties (red, 1830–2059). For Puerto Rico, the mean (SD) hospitalization rates declined for heart failure from 11 (6.2) in 1999 to 2 (1.2) in 2011 and from 11 (6.5) in 1999 to 2 (2.8) in 2011 for ischemic stroke.
Figure 3
Figure 3
Maps of current observed rates (per 100,000 person-years) of hospitalization for myocardial infarction, unstable angina, heart failure, and ischemic stroke (2011) at the county level.
See this image and copyright information in PMC

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