The number of older Americans hospitalized with heart failure declined 30 percent from 1998 to 2008, saving the U.S. health insurance program for the elderly $4.1 billion annually, researchers said.
In the largest study of its kind, investigators analyzed heart-failure hospitalizations among 55 million people in the U.S. Medicare program. An extra 229,000 hospital stays among the 27.3 million people in Medicare’s fee-for-service program in 2008 would have occurred if rates had stayed the same, the report in the Journal of the American Medical Association found.
The decline in hospital stays may be due to better cardiovascular care, improved heart-failure treatment and a focus on outpatient therapy, researchers said in today’s report. Each hospital stay costs about $18,000. The number of people with cardiovascular disease is falling as more patients get treatment for hypertension and heart rhythm devices from Medtronic Inc. (MDT) and Boston Scientific Corp. (BSX) that can reduce repeat heart failure episodes, according to the study.
“It’s a success for cardiology and for medicine to have such a decline,” said lead researcher Jersey Chen, an assistant professor of internal medicine and cardiology at Yale University School of Medicine. “Fewer people may be developing heart failure because we are preventing it. It could also be that patients who have heart failure are on medicines or have devices that prevent them from worsening again.”
The dramatic drop in hospitalizations for heart failure benefits society as well as patients, Chen said in a telephone interview. Heart failure is one of the most expensive medical conditions to treat, costing an estimated $39.2 billion in 2010, according to the American Heart Association.
Public health experts began focusing on heart-failure hospitalizations in the early 1990s, when studies showed 15 percent of patients died and 30 percent were readmitted within three months, wrote cardiologists Mihai Gheorghiade from Northwestern University Feinberg School of Medicine in Chicago and Eugene Braunwald from Brigham and Women’s Hospital and Harvard Medical School in Boston, in an editorial.
The study “is the first to document an improvement in hospitalization rates in heart failure in the United States,” they wrote.
While the study suggests heart-failure hospitalization rates have declined in recent years, “the overall mortality rate and readmission rate for heart failure remains unacceptably high,” they said. “New approaches for patients hospitalized for heart failure must be developed.”
Almost 6 million Americans suffer from heart failure and the risk increases with age. It is one of the most common causes of hospitalization and little progress had been made in developing medicines to treat it.
Slight Mortality Decline
The decline in heart-failure hospitalizations didn’t appear to hurt patients. In the study, the one-year mortality rate dipped slightly, with 29.6 percent dying within 12 months in 2008, down from 31.7 percent in 1999.
“It’s still a deadly disease, with 30 percent odds of dying in a year,” Chen said. “The success isn’t for treating heart failure. The success, as this study suggests, is in preventing the development of heart failure.”
While heart-failure hospitalization rates fell for patients of all ages and races, black men and those living in Rhode Island, Connecticut and Wyoming had the slowest decline, the study found. The risk of dying within a year actually increased in South Dakota, Arizona, Alaska, Kentucky and Louisiana.
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