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.
But the study of 55 million patients, the largest ever on heart failure trends, 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 5 million Americans and 22 million people globally have heart failure. Their hearts strain to pump blood because of damage, often from a heart attack or from high blood pressure. Fluid backing up into the lungs can leave people struggling to breathe.
Heart disease contributes to heart failure. Last week, federal health officials reported that the prevalence of self-reported heart disease in the U.S. decreased from nearly 7 percent to 6 percent from 2006 to 2010.
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.
Shortness of breath sent heart failure patient Maria Marure to several Chicago hospitals this year. In August, the 56-year-old spent a week at Our Lady of the Resurrection Medical Center, where leaders are focused on keeping heart failure patients healthy once they're home and avoiding readmissions. Next year, the nation's new health law begins punishing hospitals with high readmission rates for heart failure by shrinking Medicare payments.
The Chicago hospital made sure Marure had a medical interpreter to translate a nurse's instructions into Spanish and convey her questions. Marure said it was the first time she understood her heart failure and why it was important for her to watch her weight — which can signal excess fluid. The hospital sent her home with a scale, made sure she had home care and a nurse called her periodically.
Even with all that, in less than three weeks, Marure was struggling to breathe again. A doctor sent her to a different hospital, where she was admitted for four days.
That patient's experience illustrates why heart failure is still a challenge, despite the new findings — as does the one-year death rate found in the study. The proportion of patients who died within a year after being discharged fell, but only slightly, from about 32 percent to about 30 percent during the decade.
"The death rate is still unacceptably high," said Dr. Mihai Gheorghiade of Northwestern University's Feinberg School of Medicine in Chicago. Hospitals need to aggressively treat heart failure patients' other ailments and immediately schedule follow-up care after discharge, said Gheorghiade, who wrote an accompanying editorial in the journal.
"It is a sign of hope. However, we are far from achieving our goals," he said.