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Med Care. 2009 Oct;47(10):1106-10. doi: 10.1097/MLR.0b013e31819e1f53.

No pain, but no gain? The disappearance of angina hospitalizations, 1992-1999.

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  • 1Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts 01655-0002, USA.



Hospitalization for angina is commonly considered an ambulatory care sensitive hospitalization and used as a measure of access to primary care.


To analyze time trends in angina-related hospitalizations and seek possible explanations for an observed, marked decline during 1992 to 1999.


We analyzed Medicare claims of SEER-Medicare control subjects for occurrence of angina hospital discharges, using the Agency for Healthcare Research and Quality Prevention Quality Indicator (PQI) definition, along with occurrence of related events including angina admissions with revascularization, angina admissions discharged as coronary artery disease (CAD) or myocardial infarction, and overall ischemic heart disease discharges.


Approximately 124,000 cancer-free Medicare beneficiary/ies, with subjects contributing data for 1 to 8 years.


Angina PQI hospital discharges declined 75% between 1992 and 1999. CAD hospital discharges rose in a reciprocal pattern, while angina discharges with revascularization declined and discharges for myocardial infarction and ischemic heart disease were relatively constant during this time period.


The marked decline in angina PQI hospital discharges during 1992-1999 does not appear to represent improvements in access to care or prevention of heart disease, but rather increased coding of more specific discharge diagnoses for CAD. Our findings suggest that angina hospitalization is not a valid measure for monitoring access to care and, more generally, demonstrate the need for careful, periodic re-evaluation of quality measures.

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