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P U B L I S H E D I N C I R C U L AT I O N , the late 2014 study, "Trends in Hospitalizations and Outcomes for Acute Cardiovascular Disease and Stroke: 1999-2011," reviewed data regarding myocardial infarction, unstable angina, ischemic stroke and heart failure. Researchers examined mortality and hospi- tal readmission rates, among other factors, for these conditions in all individuals age 65 and older who participate in the Medicare fee-for-service program. Results revealed significant improvements in outcomes, as evidenced by declining trends in mortality and hospitalization. A Measure of Success The goal of the research was to evaluate what had been achieved during a period when there were not many therapeutic breakthroughs for stroke and cardiovas- cular disease, but rather an emphasis on quality and the translation of evidence to the bedside, according to Harlan M. Krumholz, MD, Director of the Center for Outcome Research and Evaluation at Yale University School of Medicine and lead author of the study. in Cardiovascular Outcomes Research Finds 'Extraordinary Progress' Researchers evaluated medical records for nearly 34 million Americans receiving Medicare. Key factors considered for the four diagnoses included hospitalization rates, mortality rates at 30 days and one year post-hospitalization, and 30-day hospital readmission rates. "To really measure the benefits of our work in trying to improve care, we have to look at what's happening with the patients," Dr. Krumholz says. "What matters in the end is what happens to the patient, so we tried to focus on the patient experience." Analyzing data from such a broad pool of Medicare patients gave researchers an advantage over smaller studies that seek to quantify the national experience. They were able to produce a report card reflective of national trends that not only outlined progress in cardiology, but also allowed for comparisons between some of the trends observed in cardiology and those seen in other medical specialties. "If we decreased the [hospitaliza- tion] rates to the same extent as other specia lties, we ca n't claim specia l credit," Dr. Krumholz explains. "We can just say this is representative of all other conditions. We wanted to make that comparison." 'Breathtaking' Results Resea rchers were astounded by their findings. Rates of hospitalization during the years covered by the study declined 38 percent for patients with myocardial infarction, 30.5 percent for patients with heart failure and 33.6 percent for those with ischemic stroke. The largest decline, however, occurred in the area of unstable angina, which saw an 83.8 percent reduction in hospitalization rates. By comparison, the decline in hospi- talization rates across all other conditions averaged 10 percent. Thirty-day readmission rates experienced the following declines: 18.6 percent for myocardial infarction, 32.3 percent for unstable angina, 9.7 percent for heart failure and 5.9 percent for ischemic stroke. Mortality rates after 30 days decreased nearly 30 percent for myocardial infarction, 13.1 percent for angina, 4.7 percent for stroke and 16.4 percent for heart failure. Observed declines in one-year mortality By Tiffany Parnell FOR MOST OF THE 21ST CENTURY, THE FOCUS OF CARDIOLOGY HAS CENTERED ON IMPROVING THE QUALITY OF CARE AND IMPLEMENTING EVIDENCE-BASED CLINICAL GUIDELINES. A RECENT STUDY SUGGESTS THOSE EFFORTS HAVE YIELDED A STRING OF REMARKABLE SUCCESSES. 6 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ M A R C H /A P R I L 2 0 1 5 COV ER FE AT UR E