October 18th, 2011

Heart Failure Hospitalization Rate Drops 30% in 10 Years

From 1998 through 2008, the rate of heart failure hospitalization in an elderly Medicare population declined by nearly 30%, according to a new study published in JAMA.

Jersey Chen and colleagues  (including senior author Harlan Krumholz, editor-in-chief of CardioExchange) analyzed CMS data from 55 million fee-for-service Medicare patients hospitalized for heart failure between 1998 and 2008. After adjusting for age, sex, and race, the investigators found that the hospitalization rate dropped over the period from 2845 to 2oo7 per 100,000 person-years (P<0.001), a relative decline of 29.5%. Although a decline was observed in all race-sex categories, the slowest rate of decline was observed in black men (from 4142 to 3201 per 100,000 person-years).

The authors calculated that the decline in the hospitalization rate resulted in 229,000 fewer hospitalizations in 2008, yielding a savings of $4.1 billion in fee-for-service Medicare. A statistically significant but modest  6.6% relative decline in 1-year mortality was also observed, from 31.7% in 1999 to 29.6% in 2008 (P<0.001).

In an accompanying editorial, Mihai Gheorghiade and Eugene Braunwald write that although the study demonstrates some progress, “the overall mortality rate and readmission rate for HF continue to remain unacceptably high.” They suggest several strategies to improve outcomes in HF patients, including a more aggressive strategy to treat subclinical congestion, treatment of cardiac abnormalities and noncardiac cormorbidities, better postdischarge follow-up, and greater utilization of underused agents like digoxin and eplerenone.

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