Vital Signs: State-Level Variation in Nonfatal and Fatal Cardiovascular Events Targeted for Prevention by Million Hearts 2022

Abstract

Introduction: Despite its preventability, cardiovascular disease remains a leading cause of morbidity, mortality, and health care costs in the United States. This study describes the burden, in 2016, of nonfatal and fatal cardiovascular events targeted for prevention by Million Hearts 2022, a national initiative working to prevent one million cardiovascular events during 2017-2021.

Methods: Emergency department (ED) visits and hospitalizations were identified using Healthcare Cost and Utilization Project databases, and deaths were identified using National Vital Statistics System data. Age-standardized Million Hearts-preventable event rates and hospitalization costs among adults aged ≥18 years in 2016 are described nationally and across states, as data permit. Expected 2017-2021 event totals and hospitalization costs were estimated assuming 2016 values remain unchanged.

Results: Nationally, in 2016, 2.2 million hospitalizations (850.9 per 100,000 population) resulting in $32.7 billion in costs, and 415,480 deaths (157.4 per 100,000) occurred. Hospitalization and mortality rates were highest among men (989.6 and 172.3 per 100,000, respectively) and non-Hispanic blacks (211.6 per 100,000, mortality only) and increased with age. However, 805,000 hospitalizations and 75,245 deaths occurred among adults aged 18-64 years. State-level variation occurred in rates of ED visits (from 56.4 [Connecticut] to 274.8 per 100,000 [Kentucky]), hospitalizations (484.0 [Wyoming] to 1670.3 per 100,000 [DC]), and mortality (111.2 [Vermont] to 267.3 per 100,000 [Mississippi]). Approximately 16.3 million events and $173.7 billion in hospitalization costs could occur during 2017-2021 without preventive intervention.

Conclusions and implications for public health practice: Million Hearts-preventable events place a considerable health and economic burden on the United States. With coordinated efforts, many of these events could be prevented in every state to achieve the initiative's goal.

FIGURE

Age-standardized overall Million Hearts–preventable event rates among adults aged ≥18 years, by U.S. state, 2016 Sources: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases; National Center for Health Statistics’ National Vital Statistics System Mortality Data. * Includes mutually exclusive nonfatal treat-and-release emergency department visits, nonfatal acute hospitalizations and deaths attributed to acute myocardial infarctions, strokes, precursor cardiovascular conditions (e.g., stable angina pectoris), and other cardiovascular conditions (e.g., heart failure). ^† Complete data are available for 34 states and the District of Columbia (DC). Supplementary Figure 1 shows age-standardized rates of treat-and-release emergency department visits for 34 states and DC, hospitalizations for 46 states and DC, and mortality for 50 states and DC (https://stacks.cdc.gov/view/cdc/58168).