According to heartening news from researchers, hospitalizations for heart failure have dropped 29.5 percent nationally over the past decade. Researchers explain that this is largely because fewer patients were admitted rather than fewer admissions per patient, researchers found.
Results revealed that the risk-adjusted rate of heart failure hospitalization fell from 2,845 to 2,007 per 100,000 person-years from 1998 to 2008. The study was a fee-for-service Medicare claims analysis by Dr. Jersey Chen of Yale University and colleagues. In addition the first ever documented decline in the US saved an estimated $4.1 billion in Medicare costs since 1998, they reported in the Oct. 19 issue of the Journal of the American Medical Association.
Overall, 55,097,390 patients were identified and had clinical characteristics examined. Participants were stratified according to age (65-74 years; 75-84 years; 85 years or older), sex and race (white, black, other).
Researchers speculate that this decline is due to the lowering of risk factors of heart failure, modest improvements in blood pressure control, better use of evidence-based therapies, and a shift toward outpatient management of heart failure may have been contributing factors, the group suggested.
The main reason for the drop in hospitalizations was fewer unique patients hospitalized for heart failure, down from 2,014 per 100,000 in 1998 to 1,462 per 100,000 in 2008. More encouragingly, one-year mortality after heart failure hospitalization also dropped modestly by a relative 6.6 percent over the same period, from a risk-adjusted rate of 31.7 percent to 29.6 percent.
Chen and his team analyzed all heart failure hospitalizations nationally in a complete sample of Medicare fee-for-service claims from 1998 to 2008 and they found that all sex and race groups showed reductions in heart failure hospitalizations. But black men had the lowest rate of decline, with heart failure hospitalizations falling from 4,142 to 3,201 per 100,000 person-years over the study period. This improvement was a significant 19 percent less than other groups after adjusting for age.
The rates didn't fall evenly across states either. Heart failure hospitalization changes happened significantly slower than the national mean in three states: Connecticut, Rhode Island, and Wyoming. One-year mortality rates actually increased in five states: South Dakota, Arizona, Alaska, Louisiana, and Kentucky.
An accompanying editorial pointed to the results as a sign of hope, though with plenty of room for improvement. The “persistently” and “unacceptably” high one-year mortality rates suggested a need for immediate attention to heart failure post-discharge practices, wrote Dr. Mihai Gheorghiade of Northwestern University in Chicago and Dr. Eugene Braunwald of Brigham and Women's Hospital and Harvard in Boston.
They suggested using more aggressive treatment for subclinical congestion, taking a mechanistic approach to underlying cardiac abnormalities, boosting use of drugs like digoxin and mineralocorticoid antagonists and scheduling an early post-discharge visit.
“There is more work to be done,” agreed Dr. Ralph Brindis, immediate past-president of the American College of Cardiology, in a statement. While overall trends are on the right track, not all groups benefited equally, he noted. He added, “We must continue to work to understand the causes of these disparities in outcomes and continue to apply what we learn through research to improve care and prevention across the board.”
The researchers cautioned that the study could not determine causality for any of the findings. Other limitations were sole inclusion of a Medicare population, which may differ in heart failure hospitalization and mortality trends from a younger population with different insurance, and use of administrative codes not confirmed clinically.
MESA heart disease risk score performs well even without race modifiers