While funds used on interventions such as rapid angioplasty have helped improve patient survival rates in the first six months following a heart attack, other interventions funded by increased Medicare spending seem to deliver little benefit, according to a study published in JAMA Cardiology.
For the study, researchers analyzed health data from 480,000 Medicare patients treated for acute myocardial infarction at 1,220 hospitals across the country between 1999 and 2014. Over the study period, survival rates within the first six months of a heart attack improved 73 percent to 78.5 percent. Spending on heart attack care also increased by 14 percent over the course of the study.
To asses to the relationship between increased spending and mortality, researchers analyzed the effect of multiple interventions on survival rates. Interventions assessed included cardiac procedures, physician visits and post-acute care, among others. Analysis revealed high variation between mortality and cost. Researchers also detected high variability regarding the effectiveness of specific interventions.
Hospitals that prioritized performing percutaneous coronary intervention on heart attack patients within the first 24 hours of the patient displaying symptoms had the most improved survival rates. These hospitals also displayed lower spending in several areas of post-acute care, including nursing home care. While spending tripled for outpatient care over the study period, patients who more frequently visited physicians after a heart attack were no less likely to die than those who had fewer outpatient visits.
"We need to develop and implement models for evaluating ways to address both quality and spending," said Donald Likosky, PhD, associate professor with the University of Michigan's Institute for Healthcare Policy and Innovation and lead author of the study. "Better involvement of frontline providers in designing and implementing change is crucial, especially if we seek to reduce variability in quality and spending. Clinical providers are likely best suited to both know what works, and why. …Right now, there's no disincentive to use cost-ineffective types of care."
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