Coronary heart disease patients requiring hospital care have declined so much that they are no longer the leading reason for a diseased patient's admission. Now it's ranked number three.
That's according to a sample of discharge records collected from 1,000 hospitals in 40 states in 2007 by the federal Agency for Health Research and Quality. The agency found that compared with a decade earlier, the number of patients with coronary heart disease who need hospital admission has declined 31%.
"A lot of people think it's because we have better control of risk factors," says AHRQ analyst Anne Elixhauser. "We've decreased smoking, we have better control of cholesterol, and blood pressure," which is credited to better lifestyle awareness and the use of drugs like statins, she says.
In fact, several other types of vascular disease are also on the decline. Hospitalizations for acute cerebrovascular disease, including stroke, are down 15% from 10 years ago and heart attacks are down 15%.
That's the good news. There's also some very bad news. Septicemia, or serious bacterial infections in blood (such as MRSA), are up a worrisome 63%. Elixhauser says the reason for the increase in blood infections has stumped health officials.
"MRSA is part of it, but we really don't know what's going on. What we do see is that cases of septicemia increased between 1993 and 1996, and then stabilized. They declined in 2000 and 2001, but since then it has been on a 45-degree angle going up from 2002 onward. It's been a constant increase over the last seven years."
Osteoarthritis hospitalizations, for degenerative joint disease—many involving joint replacement—are up 95%.
Non-specific chest pain is up 47% and mood disorders, such as depression and bipolar disorder hospitalizations, are up 21%.
The data is drawn from H-CUP Facts and Figures, and compared hospital based care between 1997 and 2007. It is available at www.hcup-us.ahrq.gov.
Ranked by order of number of hospitalizations from 1 to 10, the diseases:
- Pneumonia
- Congestive heart failure
- Coronary atherosclerosis
- Osteoarthritis
- Non-specific chest pain
- Mood disorders
- Cardiac dysrhythmias
- Septicemia
- Disorders of vertebral discs and bones in the spinal column
- Heart attack
Among other important trends culled from the report are:
- In 2007, Medicare stays amounted to $156 billion and Medicaid stays accounted for $50.4 billion, a total of about 60% of aggregate hospital costs. Discharges billed to private insurance accounted for 31%, or $107.8 billion, while the uninsured accounted for a smaller share, $16.5 billion, or 5%.
- Hospitalizations billed to Medicare and Medicaid accounted for more than 75% of the increase in discharges from 1997 to 2007.
- Average length of stay for hospitalizations billed to Medicare decreased from 6.3 days to 5.6 days, but the average length of stay for care covered by Medicaid, uninsured, and private insurance remained unchanged.
- Chronic conditions were the main reason for 40% of all hospitalizations in 1997 and 37% in 2007.
- The number of hospital discharges increased from 34.7 million in 1997 to 39.5 million in 2007, or a 14% increase.
- The average length of stay in 2007 was 4.6 days, almost 20% shorter than in 1993, when the average stay was 5.7 days.
- The number of patients who left hospital care against medical advice increased by 39%, for a total of 103,000 discharges, the second fastest of any discharge type.
- The number of discharges to nursing homes and long-term care facilities increased by 32% while the number of discharges to home healthcare increased by 55%.
- Blood transfusions occurred in one of every 10 hospital stays that involved a procedure, and there were 1.1 million stays involving a procedure in 1997 and 2.6 million in 2007, a growth of 140%.
- Diagnostic cardiac catheterization was performed on 890,000 males and 582,000 females in 2007, and was the second most frequent procedure in men and the fourth most frequent in women.
- From 1997 to 2007, arthroplasty of the knee operations increased by 86%.