Medicare heart hospitalizations down

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Thirty percent fewer Medicare beneficiaries needed to be hospitalized for heart failure in 2009 than a decade earlier, Yale researchers found.

Their research, which was published on Oct. 19in the Journal of American Medical Association, details the statistical methods used to calculate that the rate of hospitalization for heart failure in 2009 was only 70 percent the rate in 2001. . Jersey Chen MED ’00, assistant professor of medicine at the Yale School of Medicine and one of the authors of the paper, said the cause of this improvement was unknown, but that it was an unexpected improvement, signaling an improvement in treatment techniques as well as saving hospitals money.

“A 30 percent decline represents a thousand hospitalizations less in 2009 compared to 2001,” Chen said. “In terms of hospital costs, this saved a lot of money.”

Harlan Krumholz ’80, professor of cardiology at the Medical School and a co-author of the study, said that the results of the study are “breathtaking,” because there have been no miracle drugs invented during the period. But he added that heart failure is still a major problem.

Krumholz explained that to find this statistic the team analyzed the results of hospitalization rates in national and regional contexts from 1998 to 2008. He added that they only looked at Medicare patients’ records, because Medicare is the only major national body that collects this type of data.

“This is not a victory over heart disease, but it represents substantial progress,” Krumholz said.

Although the causes for this trend are still unknown, Chen said he hypothesizes that the results could be due to physicians controlling risk factors better. A larger variety of drugs could also have contributed to the decline, he said, as might an improvement in the way physicians treated outpatients. The next step in the research, Chen said, is correlating individual risk factors such as smoking, high cholesterol, diet and inactivity with the study’s result.

Krumholz added that the team is working with Medicare to develop interactive websites which would enable people to detect trends more quickly, compared to this study which only gave results 10 years after the trend began.

Though he hoped for a continuation of the trend, Krumholz warned that in hard economic times the rates might increase as people felt more stress, a risk factor for heart problems. He added that a key way to reduce heart failure was healthier habits. Physicians should advise their patients how to live healthier lives before they put themselves at risk of heart failure, he said.

“As a physician your greatest hope is that you put yourself out of business,” Krumholz said.

Gerard Anderson, a professor at the John Hopkins School of Public Health, said that the paper contains significant policy and clinical findings, but stressed that the good news shoud not be exaggerated. The study is less impressive in an international context, where the U.S. lags behind other industrialized countries in treating heart failure, he said.

Other authors of the paper include professor of health care policy at Harvard Medical School Sharon-Lise Normand and assistant professor of cardiology at the Yale School of Medicine Yun Wang.

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