For Medicare beneficiaries with acute myocardial infarction (AMI), short-term mortality and readmission rates have improved during the last 20 years, according to study results published in JAMA Network Open.

However, the results also indicated that the rate of in-hospital procedures and costs has increased during this time.

The study included Medicare fee-for-service beneficiaries aged 65 years or older who were hospitalized for AMI between January 1, 1995, and December 31, 2014, across 5680 hospitals in the United States (n=4,367,485).

The primary outcomes were 30-day all-cause mortality at the patient, hospital, and county levels. Secondary outcomes included 30-day all-cause readmissions, 1-year recurrent AMI, in-hospital mortality, length of hospital stay, 2014 Consumer Price Index-adjusted median Medicare inpatient payment per AMI discharge, and rates of catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery.

Between 1995 and 2014, the researchers noted a decline in AMI hospitalizations, with 914 per 100,000 beneficiary-years in 1995 compared with 566 in 2014. They also saw a decrease in 30-day all-cause readmissions, with 21.0% in 1995 compared with 15.3% in 2014, as well as a decrease in 1-year recurrent AMI (from 7.1% to 5.1%).

However, the 2014 Consumer Price Index-adjusted median Medicare inpatient payment per AMI discharge rose from $9282 to $11,031. The rate of 30-day inpatient catheterization and inpatient percutaneous coronary intervention rose as well, going from 44.2% to 59.9% and from 18.8% to 43.3%, respectively.

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Rates of coronary artery bypass graft surgery declined from 14.4% in 1995 to 10.2% in 2014.

“Overall, however, we describe 2 decades of marked improvements in outcomes for AMI among the increasingly smaller number of people in the United States who experience it, representing a transition in the impact of this condition,” the researchers wrote.

Reference

Krumholz HM, Normand ST, Wang Y. Twenty-year trends in outcomes for older adults with acute myocardial infarction in the United States. JAMA Netw Open. 2019;2(3):e191938.