Format

Send to

Choose Destination
See comment in PubMed Commons below
Circulation. 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.

Author information

1
From the Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., Y.W.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N., Y.W.). harlan.krumholz@yale.edu.
2
From the Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., Y.W.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N., Y.W.).

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

PMID:
25135276
PMCID:
PMC4171056
DOI:
10.1161/CIRCULATIONAHA.113.007787
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center