Hospital admissions for heart failure fall across the US
JAMA 2011;306:1669-78 [PubMed ® Abstract]
Hospital admissions for heart failure in the US fell by just under a third between 1998 and 2008, according to a study of healthcare claims made by adults of 65 or over. Rates of hospital admission among more than 55 million Medicare beneficiaries fell from 2845 per 100 000 person years to 2007 per 100 000 person years during the decade (P<0.001), a relative decline of 29.5%.
Declines in ischaemic heart disease, better control of hypertension, improved secondary prevention, and changes to the threshold for admission are all plausible contributors to the downward trend, say the authors.
Trends in deaths were less impressive. Although one year mortality fell slightly from 31.7% in 1999 to 29.6% in 2008 (P<0.001), survival remains unacceptably poor, says a linked editorial (p 1705). Risk of readmission is another serious problem that shows no sign of improvement. The trends in hospital admission reported here resulted from fewer patients being admitted, not fewer admissions per individual. Doctors managing patients with heart failure should treat acute episodes more aggressively (and consider underused drugs such as digoxin), pay more attention to comorbidities such as hypertension and diabetes, look more carefully for underlying causes of heart failure, and schedule at least one follow-up visit after discharge, says the editorial.
© 2011 BMJ Publishing Group Ltd.