Karol E. Watson, MD, PhD, FACC reviewing
But geographical areas with greater financial burdens show less improvement.
How much have treatments and outcomes for acute myocardial infarction (AMI) changed among older patients in the U.S.? To assess recent trends, investigators analyzed Medicare data from 1995 through 2014, during which almost 4.4 million fee-for-service beneficiaries aged ≥65 were hospitalized with AMI.
Over this period, significant decreases were seen in the percentages of female patients (50% to 46%) and white patients (91% to 86%), while the proportion of black patients increased (6% to 8%). Hospitalizations for AMI decreased (914 to 566/100,000 beneficiary-years).
The primary outcome, 30-day mortality, decreased significantly from 1995 to 2014 (20% to 12%). Decreases were also seen in 30-day all-cause readmissions (21% to 15%), 1-year recurrent AMI rates (7% to 5%), and in-hospital mortality (15% to 7%). Inpatient interventions significantly changed, with percutaneous coronary intervention rates increasing (19% to 43%) and coronary-artery bypass grafting rates decreasing (14% to 10%). The adjusted median Medicare inpatient payment per AMI discharge increased (US$9282 to $11,031). Counties that were less likely to show improved AMI mortality had a high proportion of Medicare beneficiaries not enrolled in Medicare Part B, high unemployment, and more years of potential life lost.
These data reflect only Medicare fee-for-service trends and might not apply to other patient populations. Still, the improvements in outcomes were consistent across sex and racial-ethnic subgroups. Unfortunately, disparities in outcomes continue, as seen in the by-county analyses. Overall, this report nicely outlines changing practice patterns, successes, potential threats, a modest increase in costs, and areas for improvement.