Fewer Patients Hospitalized for Heart Failure, U.S. Study Finds
Number of cases is down, but there are still too many, expert says
By Steven Reinberg
TUESDAY, Oct. 18 (HealthDay News) -- In the past decade, the number of Medicare patients hospitalized for heart failure has dropped significantly, researchers report.
"In the past 10 years, there has been a 30 percent drop in the heart failure hospitalization rate across the whole United States," said lead researcher Dr. Jersey Chen, an assistant professor of cardiology at Yale University School of Medicine. "That's a large decrease."
The lower rate of hospitalization is most likely due to several factors, Chen said. Fewer people are developing heart failure because there are fewer cases of cardiovascular disease, fewer heart attacks and better control of risk factors such as high blood pressure. Also, people who suffer from heart failure are getting better outpatient care, which prevents the condition from becoming so serious the patient needs to be hospitalized, Chen explained.
"Regardless of the cause, a 30 percent drop is surprising," Chen said. "It has saved the health system quite a bit of money."
In 2008, the decline in hospitalization for heart failure meant that 229,000 fewer people were hospitalized. Since each hospitalization costs about $18,000 per patient, Medicare saved $4.1 billion in 2008 alone, the researchers found.
The report was published in the Oct. 19 issue of the Journal of the American Medical Association.
For the study, Chen's team collected data on over 55 million Medicare patients hospitalized between 1998 and 2008 for heart failure. Over the 10-year period, the average age of hospitalized heart patients rose from 79 to 79.9.
In addition, the percentage of women hospitalized dropped from 58.9 percent to 55.7 percent. However, the proportion of black patients hospitalized for heart failure increased from 11.3 percent in 1998 to 11.7 percent in 2008, the researchers found.
Overall, hospitalization for heart failure dropped 29.5 percent during the period. The drop in hospitalization was seen in all groups, but the decline was lowest among black men, the study authors noted.
The rate of decline in heart failure hospitalizations varied by state, Chen's group found. In 16 states, the drop was higher than the national average. The greatest drop was seen in Vermont, but in Wyoming, Rhode Island and Connecticut the decline was significantly lower than the national average, the researchers reported.
In addition, deaths at one year from heart failure also decreased from 31.7 percent in 1999 to 29.6 percent in 2008.
The drop in deaths also varied by state, with four states having a statistically significant decline and five states where deaths increased significantly. Deaths ranged from a low of 29.1 percent in Maine to a high of 35.2 percent in Arizona, the investigators found.
Dr. Mihai Gheorghiade, associate director of the Center for Cardiovascular Innovation at Northwestern University Feinberg School of Medicine and co-author of an accompanying editorial, said that "the study is encouraging, but we still have a big problem with mortality and morbidity."
"The good news is that we have most of the ingredients to improve outcomes," Gheorghiade said.
Heart failure, he noted, is not one disease, but is a catch-all for different disorders. These can include a problem with a heart valve, heart muscle or coronary arteries, Gheorghiade explained.
"There is specific therapy for different types of heart failure," he said.
Although there are fewer people being hospitalized for heart failure, there are still too many people suffering from the condition and being hospitalized, Gheorghiade said. "The rate is still very high," he noted.
Gheorghiade thinks these numbers can be reduced further with better adherence to the treatment guidelines and improved care. "If you apply the guidelines, if you give the available therapy, there is huge hope for a patient with heart failure," he said.
As the population ages, there will be more people living with heart failure, increasing the burden on the Medicare system, Gheorghiade added. "Stay tuned, because this condition is going to increase, increase, increase, because it's age-related," he said.
For more information on heart failure, visit the U.S. National Library of Medicine.SOURCES: Jersey Chen, M.D., M.P.H., assistant professor, cardiology, Yale University School of Medicine, New Haven, Conn.; Mihai Gheorghiade, M.D., professor, cardiology and surgery, and associate director, Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago; Oct. 19, 2011, Journal of the American Medical Association Related Articles
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