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Coronary Artery Disease, Acute Myocardial Infarction, and Ischemic Stroke Rates Among Inpatient Stays, 2001-2014

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Coronary Artery Disease, Acute Myocardial Infarction, and Ischemic Stroke Rates Among Inpatient Stays, 2001-2014 HEALTHCARE COST AND Agency for Healthcare UTILIZATION PROJECT Research and Quality STATISTICAL BRIEF #241 July 2018 Highlights Coronary Artery Disease, Acute Myocardial ■ From 2001 to 2014, the rate of Infarction, and Ischemic Stroke Rates atherosclerotic cardiovascular Among Inpatient Stays, 2001–2014 disease (ASCVD) inpatient stays among adults decreased Quyen Ngo-Metzger, M.D., M.P.H., Arlene S. Bierman, M.D., M.S., 41.5 percent, from 1,192.9 to Amanda Borsky, Dr.P.H., M.P.P., Kevin C. Heslin, Ph.D., 698.0 stays per 100,000 adults. Brian J. Moore, Ph.D., and Marguerite L. Barrett, M.S. ASCVD is defined here as coronary artery disease (CAD), Introduction acute myocardial infarction (AMI), or ischemic stroke. Atherosclerotic cardiovascular disease (ASCVD) refers to disease ■ The percentage of stays for of the heart and blood vessels due to the accumulation of plaques. ischemic stroke resulting in an ASCVD can limit blood flow to the heart (coronary artery disease) in-hospital death decreased and lead to dangerous cardiovascular events such as heart 38.1 percent from 2001 to 2014; attacks (acute myocardial infarction). ASCVD in the blood vessels in-hospital deaths also of the brain can decrease blood flow to the brain and result in decreased 29.3 percent during ischemic strokes. Heart disease and stroke are among the top this time among stays for AMI. five leading causes of death.1 ■ In 2014, the rate of ASCVD When these events do occur they often result in inpatient stays per 100,000 adults was hospitalizations. Hospitalizations can put patients at greater risk highest in low-income areas and for additional complications, such as hospital-associated infections progressively decreased as and even death.2,3,4 community-level income increased. Specifically, there ASCVD places a substantial burden on the U.S. health care were 855.8 stays per 100,000 system. The direct medical costs from coronary artery disease adults in the lowest income and stroke are currently estimated to be $126 billion per year and areas compared with 536.1 are expected to rise to $309 billion by 2035.5 stays per 100,000 adults in the wealthiest communities. This Healthcare Cost and Utilization Project (HCUP) Statistical ■ The rate of stays for CAD was Brief presents data on adult inpatient stays with a principal 69.3 percent higher in the lowest diagnosis of ASCVD, defined as one of three specific diagnoses: income areas than in the coronary artery disease (CAD), acute myocardial infarction (AMI), wealthiest areas in 2014 (222.0 and ischemic stroke (referred to hereinafter as stroke). The rate of vs. 131.2 stays per 100,000 ASCVD stays among adults aged 18 years and older is provided along with the percentage of ASCVD stays with an in-hospital adults). ■ The rate of ASCVD stays 1 Murphy SL, Xu J, Kochanek KD, Curtin SC, Arias E. Deaths: final data for 2015. among adults in 2014 was 31.2 National Vital Statistics Reports. 2017;66(6):1–75. percent lower in large 2 U.S. Department of Health and Human Services, Office of the Inspector General. Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries. metropolitan areas than in rural November 2010. www.oig.hhs.gov/oei/reports/oei-06-09-00090.pdf. Accessed April 17, areas (667.7 vs. 969.8 stays per 2018. 100,000 adults). 3 Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care–associated infections. New England ■ The rate of stays for AMI was Journal of Medicine. 2014;370:1198–1208. 40.1 percent lower in large 4 Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure.” JAMA. 2011;306(16):1782–93. metropolitan areas than in rural 5 American Heart Association. Cardiovascular Disease: A Costly Burden for America, areas in 2014 (239.8 vs. 400.1 Projections Through 2035. 2017. www.heart.org/idc/groups/heart- stays per 100,000 adults). public/@wcm/@adv/documents/downloadable/ucm_491543.pdf. Accessed April 17, 2018. 1 death from 2001 to 2014, overall and for specific subgroups defined by diagnosis (AMI, stroke, CAD) and by procedure (percutaneous transluminal coronary angioplasty [PTCA] and coronary artery bypass graft [CABG]). The rate of adult ASCVD stays in 2014 is also presented by community-level income and by patient location. Differences greater than 10 percent between estimates are noted in the text. Findings Inpatient stays among adults with a principal diagnosis of ASCVD, 2001–2014 Figure 1 presents the rate of ASCVD inpatient stays per 100,000 adults from 2001 to 2014, overall and for each of the three specific ASCVD diagnoses—AMI, stroke, and CAD. Figure 1. Inpatient stays for ASCVD among adults, 2001–2014 1,400 Total AMI Stroke CAD 1,192.9 1,200 1,000 Total: 41.5% cumulative decrease 800 698.0 580.0 600 AMI: 22.8% cumulative decrease Rate of InpatientStays 400 340.0 per 100,000 per 100,000 Adult Population 262.6 259.0 200 272.8 Stroke: 5.1% cumulative decrease 176.5 CAD: 69.6% cumulative decrease 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year Abbreviations: AMI, acute myocardial infarction; ASCVD, atherosclerotic cardiovascular disease; CAD, coronary artery disease Notes: Inpatient stays are based on principal diagnoses. Cumulative percent change is reported based on unrounded rates. ASCVD is defined here as a diagnosis of CAD, AMI, or ischemic stroke. Total refers to the sum of the three specific ASCVD diagnoses of CAD, AMI, and stroke. Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID), 2001–2014, weighted to provide national estimates ■ The rate of inpatient ASCVD stays per 100,000 adults generally decreased from 2001 through 2014, for a total 41.5 percent cumulative decrease. From 2001 to 2014, the rate of total ASCVD stays among adults decreased 41.5 percent, from 1,192.9 stays per 100,000 adults in 2001 to 698.0 stays per 100,000 adults in 2014. Among adult ASCVD stays, the rate of stays with a principal diagnosis of CAD decreased 69.6 percent from 2001 to 2014, from 580.0 to 176.5 stays per 100,000 adults. Stays with a principal diagnosis of AMI decreased 22.8 percent, from 340.0 to 262.6 stays per 100,000 adults. Stays with a principal diagnosis of stroke remained relatively stable at around 260–270 stays per 100,000 adults between 2001 and 2014. 2 Figure 2 presents the rate per 100,000 adults of ASCVD inpatient stays during which either of two common cardiovascular procedures—PTCA or CABG—were performed, from 2001 to 2014. Figure 2. Adult ASCVD inpatient stays with common cardiovascular procedures, 2001–2014 ASCVD stays with PTCA ASCVD stays with CABG 350 332.9 300 271.5 34.4% cumulative decrease 22.6% increase 250 (2001–2014) (2001–2005) 200 178.1 150 134.2 45.1% cumulative decrease (2001–2014) 100 73.6 per 100,000 per 100,000 Adult Population Rate of ASCVD Inpatient Stays 50 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CABG, coronary artery bypass graft; PTCA, percutaneous transluminal coronary angioplasty Notes: Inpatient stays are based on principal diagnoses and all-listed procedures. Cumulative percent change is reported based on unrounded rates. ASCVD is defined here as a diagnosis of coronary artery disease, acute myocardial infarction, or ischemic stroke. Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID), 2001–2014, weighted to provide national estimates ■ The rate of ASCVD stays involving PTCA increased from 2001 to 2005 and then decreased from 2005 to 2014. The rate of ASCVD stays that involved PTCA increased 22.6 percent between 2001 and 2005, from 271.5 to 332.9 stays per 100,000 adults, and then decreased after 2005. Overall, from 2001 to 2014, the rate of adult ASCVD stays that involved PTCA decreased 34.4 percent, to 178.1 stays per 100,000 adults. ■ The rate of ASCVD stays involving CABG generally decreased from 2001 to 2014. From 2001 to 2014, the rate of adult ASCVD stays that involved CABG decreased 45.1 percent, from 134.2 stays per 100,000 adults in 2001 to 73.6 stays per 100,000 adults in 2014. 3 In-hospital deaths among adult inpatient stays with a principal diagnosis of ASCVD, 2001–2014 Figure 3 presents the percentage of adult ASCVD stays that resulted in an in-hospital death from 2001 to 2014 for each of the three specific ASCVD diagnoses—AMI, stroke, and CAD. Figure 3. In-hospital deaths among adult ASCVD inpatient stays, 2001–2014 Stroke AMI CAD 12 11.0 10 Stroke: 38.1% cumulative decrease 8.2 8 7.7 Hospital Death,% - AMI: 29.3% cumulative decrease 6 5.1 4 2 CAD: 3.6% cumulative increase 0.7 ASCVD ASCVD Stays With In 0.8 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year Abbreviations: AMI, acute myocardial infarction; ASCVD, atherosclerotic cardiovascular disease; CAD, coronary artery disease Notes: Inpatient stays are based on principal diagnosis. Cumulative percent change is reported based on unrounded rates. ASCVD is defined here as a diagnosis of CAD, AMI, or ischemic stroke. Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID), 2001–2014, weighted to provide national estimates ■ From 2001 to 2014, the percentage of ASCVD stays with an in-hospital death decreased 38.1 percent among stays for stroke and decreased 29.3 percent among stays for AMI.
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