Carla K. Johnson, AP
Hospital stays for heart failure fell a remarkable 30 percent in Medicare patients over a decade, the first such decline in the United States and forceful evidence that the nation is making headway in reducing the billion-dollar burden of a common condition. However, the study found only a slight decline in deaths within a year of leaving the hospital, and progress lagged for black men. "While heart failure hospitalizations have decreased nationally overall, certain populations haven't seen the full benefit of that decrease," said lead author Dr. Jersey Chen of Yale University School of Medicine.
Possible explanations for the decline in hospital stays abound, including healthier hearts, better control of risk factors like high blood pressure, and more patients treated in emergency rooms and clinics without being admitted to hospitals, said Dr. Mariell Jessup, medical director of the Penn Heart and Vascular Center in Philadelphia. "I think it's extraordinary news," said Jessup, who wasn't involved in the new research. "Many efforts at changing the natural history of this disease seem to be having an effect, especially with the hospitalization rate, but it's still a very problematic disease."
More than five million Americans and 22 million people globally have heart failure.
Fewer hospital stays saves Medicare a lot of money because heart failure is the most common cause of hospitalization in older patients. From 1998 to 2008, the rate fell from 2,845 hospitalizations per 100,000 Medicare beneficiaries to 2,007 per 100,000, according to research appearing in Wednesday's Journal of the American Medical Association. If the rate had remained the same, there would have been 229,000 more heart failure hospital stays in 2008 at an additional cost to Medicare of $4.1 billion, Chen said.
Other reasons for declining hospital stays may include specialized pacemakers and better use of medications such as ACE inhibitors that relax blood vessels, diuretics that prevent fluid buildup, digoxin that boosts heartbeat strength and beta blockers that ease strain on the heart.