title: Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, 1999-2011.
abstract: BACKGROUND
  During the past decade, efforts focused intensely on improving the quality of care for people with, or at risk for, cardiovascular disease and stroke. We sought to quantify the changes in hospitalization rates and outcomes during this period.
  
  
  RESULTS
  We used national Medicare data to identify all Fee-for-Service patients ≥65 years of age who were hospitalized with unstable angina, myocardial infarction, heart failure, ischemic stroke, and all other conditions from 1999 through 2011 (2010 for 1-year mortality). For each condition, we examined trends in adjusted rates of hospitalization per patient-year and, for each hospitalization, rates of 30-day mortality, 30-day readmission, and 1-year mortality overall and by demographic subgroups and regions. Rates of adjusted hospitalization declined for cardiovascular conditions (38.0% for 2011 compared with 1999 [95% confidence interval (CI), 37.2-38.8] for myocardial infarction, 83.8% [95% CI, 83.3-84.4] for unstable angina, 30.5% [95% CI, 29.3-31.6] for heart failure, and 33.6% [95% CI, 32.9-34.4] for ischemic stroke compared with 10.2% [95% CI, 10.1-10.2] for all other conditions). Adjusted 30-day mortality rates declined 29.4% (95% CI, 28.1-30.6) for myocardial infarction, 13.1% (95% CI, 1.1-23.7) for unstable angina, 16.4% (95% CI, 15.1-17.7) for heart failure, and 4.7% (95% CI, 3.0-6.4) for ischemic stroke. There were also reductions in rates of 1-year mortality and 30-day readmission and consistency in declines among the demographic subgroups.
  
  
  CONCLUSIONS
  Hospitalizations for acute cardiovascular disease and stroke from 1999 through 2011 declined more rapidly than for other conditions. For these conditions, mortality and readmission outcomes improved.
authors.affiliation: From the Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., Y.W.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N., Y.W.). harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: From the Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., Y.W.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N., Y.W.).
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.affiliation: From the Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., Y.W.); Department of Health Care Policy, Harvard Medical School, Boston, MA (S.-L.T.N.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.-L.T.N., Y.W.).
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D018588:Fee-for-Service Plans; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D010359:Patient Readmission; D020521:Stroke / Q000401:mortality*; D013997:Time Factors
keywords: heart diseases; patient outcome assessment; patient readmission; stroke; trends