Heart failure care improving, costs falling: Study


(CBS/AP) The nation has a new reason to take heart. Over the past decade, hospital stays for heart failure dropped 30 percent in Medicare patients.

The drop is forceful evidence that the U.S. is making headway in reducing the billion-dollar burden of a common condition - and America's #1 killer.

Why are heart failure hospitalizations on the decline? Possible explanations include 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.

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.

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 rate of self-reported heart disease in the U.S. decreased from nearly 7 percent in 2006 to 6 percent in 2010.

What does this mean for Medicare? A lot of money saved.

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, said the study's lead author, Dr. Jersey Chen, of Yale University School of Medicine.

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 the hospital made sure Marure had a medical interpreter translating between Spanish and English, and made sure that she had home care and a nurse called her periodically. Still, three weeks after being sent back home, Marure was struggling to breathe again and was sent to a different hospital. Next year, the nation's new health law begins punishing hospitals with high readmission rates for heart failure by shrinking Medicare payments.

Marure'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.