A new investigation published in the October 19 issue of JAMA revealed that hospitalizations related to heart-failure had declined considerably among Medicare patients between 1998 and 2008, although at a lower rate for black men. In addition, they also revealed that during this time one year mortality rates declined slightly, but still remain high.

According to the report:

“Heart failure (HF) imposes one of the highest disease burdens of any medical condition in the United States with an estimated 5.8 million patients experiencing HF in 2006. The risk of developing HF increases with advancing age, and as a result, HF ranks as the most frequent cause of hospitalization and re-hospitalization among older Americans. Heart failure is also one of the most resource-intensive conditions with direct and indirect costs in the United States estimated at $39.2 billion in 2010.

It is not known whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in HF hospitalization and mortality.”

In order to identify heart failure hospitalization rates and 1-year mortality rates after HF hospitalization, Jersey Chen, M.D., M.P.H., of the Yale University School of Medicine, New Haven, Conn., and his team carried out an investigation that involved data of 55,097,390 individuals who received fee-for service Medicare who had been hospitalized between 1998 and 2008 with a principal discharge diagnosis code for heart failure. Patients examined in the investigation were from acute care hospitals in Puerto Rico and the U.S.. Over the course of the investigation the average age for heart failure patients rose from 79.0 years to 79.9 years. The ratio of female patients decreased from 58.9% to 55.7% and the ratio of black patients increased from 11.3% to 11.7%.

After evaluating the data between 1998 and 2008 the researchers discovered a relative decrease of 29.5% in the overall risk-adjusted heart failure hospitalization rate. Age-related heart failure hospitalization rates declined for all race-sex categories over the study period, although black men had the lowest rate of decline.

They discovered that from state to state the risk-standardized rates for heart failure hospitalization varied considerably. The decline in HF hospitalization rates was considerably lower in three states (Connecticut, Wyoming and Rhode Island) but much higher than the change in the national rate in 16 states.

In addition they found that between 1999 and 2008 the risk-adjusted 1-year mortality rate decreased from 31.7% to 29.6%, a relative decline of 6.6%, which varied considerably from state to state. Statistically, there was a significant increase in 1-year risk-standardized mortality rates between 1998 and 2008 in 5 states and a significant decline in four states.

The researchers state that compared to the heart failure hospitalization rate in 1998, in 2008 it was estimated that 229,000 heart failure hospitalizations did not occur. “With a mean HF hospitalization cost of $18,000 in 2008, this decline represents a saving of $4.1 billion in fee-for-service Medicare.”

They conclude that the overall decline was mainly due to less patients being hospitalized with heart failure rather than a reduction in the prevalence of heart failure hospitalizations. In addition, the substantial geographic variation in heart failure hospitalization and 1-year mortality rates show significant variations in outcomes that are not explained by insurance status.

In an associated report, Mihai Gheorghiade, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and Eugene Braunwald, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, explain that:

“even though the study by Chen et al suggests that rates of HF hospitalization may have declined in recent years, the overall mortality rate and readmission rate for HF continue to remain unacceptably high.

New approaches for patients hospitalized for HF must be developed and implemented. Given the differences in hospitalizations for HF based on race and region noted by Chen et al, further exploration is required. A more in-depth and longitudinal characterization of this patient population is necessary to help shape future team-based management strategies.

Written by Grace Rattue