Heartening trends: Battle against heart disease in U.S. makes major strides

A decade of efforts to improve outcomes for patients with acute MI and stroke have made significant progress, according to a study published Aug. 18 in Circulation.

The research team led by Harlan M. Krumholz, MD, SM, of Yale University School of Medicine in New Haven, Conn., reviewed Medicare fee-for-service data from 1999 through 2011. They found that the efforts of professional societies and governmental groups to improve outcomes for these patients had an impact by introducing quality healthcare processes, raising awareness of treatment options and working with patients to change lifestyle factors that led to or exacerbated conditions.

Hospitalization rates declined. MI hospitalizations declined by 38 percent. Unstable angina hospitalizations saw the greatest decrease, dropping by 83.8 percent. Heart failure, ischemic stroke and other cardiovascular conditions declined by 30.5 percent, 33.6 percent and 10.5 percent, respectively.    

Further declines were noted in 30-day mortality: MI, unstable angina, and heart failure declined by 29.4 percent, 13.1 percent and 16.4 percent, respectively. Ischemic stroke 30-day mortality declined by 4.7 percent. One-year mortality declined by 13.1 percent for ischemic stroke, and 23.4 percent, 21.1 percent and 13 percent, respectively, for MI, unstable angina and heart failure.

Areas where increases and inconsistent declines across the diagnoses included Medicare payments for hospitalizations and home discharge. However, mean lengths of stay decreased across the board, decreasing by 1.2 days for MI and 0.6 days for both unstable angina and heart failure. Ischemic stroke decreased mean length of stay by 1.1 days.

Professional societies lauded the results. The Society for Cardiovascular Angiography and Interventions (SCAI) released a statement in which SCAI President Charles Chambers, MD, said, “The report shows cardiovascular outcomes are improving, to a point where one day, as the authors state, we may be able to remove cardiovascular disease from among the top causes of death and disability in this country.” Chambers added that continued quality and joint initiatives nationwide were key to making that happen.

American College of Cardiology President Patrick O’ Gara, MD, stated in another release that the declines were consistent with changes in attitudes about healthy lifestyles and improving diet and exercise, as well as smoking cessation. He noted that this was occurring “at a time when cardiovascular medicine is leading the way in supporting evidence–based care through the use of data registries. Our goal is to see that these trends contine by encouraging healthy lifestyles and also by our support of performance measures for the entire cardiovascular team.”

Krumholz stated in release, “We saw consistent improvements in the use of evidence-based treatements and medications and saw an increase in quality improvement initiatives using registries and other data to track performance and support efforts – as well as a strong emphasis on heart-healthy lifestyles and behaviors.”

"There is still more work to do as heart disease and stroke combined remain the leading cause of death and disability, but this study documents astonishing progress and national achievement," Krumholz said.