Smaller proportion of Medicare patients hospitalized for heart problems

(Press-News.org) Heart-related problems accounted for a smaller proportion of hospitalizations among Medicare beneficiaries within the past ten years than did other causes for hospitalization, researchers reported at the American Heart Association's Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 2011 Scientific Sessions.

The study, the largest within the past decade to look at hospitalization rates among Medicare beneficiaries, found that the proportion of heart disease hospitalizations is falling at a faster rate than those from other leading causes of hospital admissions.

"We're seeing that common cardiac diseases are accounting for a smaller proportion of hospitalizations within the United States," said Amit H. Sachdev, the study's lead author and a fourth-year medical student at New York University School of Medicine. "We believe this may reflect an improvement in medical care and preventive efforts and in delivering healthcare in the United States over the last decade."

From 1998 to 2008, the proportion of acute care hospitalizations declined for six of the eight leading causes of admissions. Coronary artery disease saw the largest drop, according to the study: 538,749 hospital admissions in 1998 compared to 409,763 in 2008. Heart attack saw the second-largest decline, falling from 358,251 in 1998 to 311,276 by 2008. Among the most common heart-related conditions, the total proportion of hospital admissions fell: 31.7 percent for coronary artery disease; 22.2 percent for heart attack; 16.8 percent for heart failure; and However, the total proportion of hospitalizations for cardiac arrhythmia (irregular heartbeat) increased 10.5 percent.

For non-heart related conditions, the total proportion of hospital admissions declined: 18.9 percent for pneumonia; 14.5 percent for fluid and electrolyte disorders; 11.6 percent for hip fracture. The proportion of hospitalizations for chronic bronchitis, however, increased 8.5 percent.

Researchers analyzed data from more than 11 million Medicare beneficiaries who were hospitalized for any cause in 1998. The total number of hospitalizations reached roughly 13 million in 2008.

Sachdev said increased government efforts to improve cardiac care may help explain the findings.

"Heart disease is the leading cause of hospitalization in the United States, so you see a lot of government money focused at cardiac conditions," he said.

He cited better diagnostic tests, physicians getting more heart disease education, and more frequent use of medications to prevent or control heart disease.

Calling the findings "informative and encouraging," Sachdev said the next step will be determining why the hospitalization rate is falling for some conditions, and rising for others. Future research must also tease out which specific groups are being affected more or less, he said.

"This study looks at the entire country in one broad-brush stroke," said Sachdev, who is also a research fellow with the Yale/Yale New Haven Center of Outcomes Research and Evaluation where the study was conducted. "Future studies within our research group are going to delve into racial and regional differences in healthcare delivery. Our goal is to ensure quality care and equal care to everyone in the United States,"

Researchers noted the findings can only be applied to an older population that Sachdev said is expected to double in size over the next 15 years.

"You would expect, naturally, that as the size of the population increases, you would get more people being hospitalized," he said. "So, further efforts in therapeutic and preventive interventions must be made to continue to see these declines."

Sachdev recommends patients work closely with their physician to learn how to prevent or manage heart disease. Avoid hospitalization by eating a healthy diet, exercising regularly, taking the right medication and attending regular follow-up appointments with a physician, he said.

### Co-authors are Yun Wang, Ph.D.; Susannah M. Bernheim, M.D.; Harlan M. Krumholz, M.D., S.M.; and Joseph S. Ross, M.D. Author disclosures are on the abstract.

The National Heart, Lung, and Blood Institute funded the study.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

NR11-1076 (QCOR11/Sachdev)

(Actual presentation time is 5 p.m. ET, Thursday, May 12, 2011)