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Heart attack victims over 65 suffer worse outcomes but have lower hospital charges

Despite staying in the hospital on average a half-day longer, older patients had lower total charges, perhaps due to the lack of expensive procedures

Jeff Lagasse, Associate Editor

Heart attack victims over the age of 65 are less likely than younger patients to receive timely coronary intervention to open their blocked heart arteries, according to preliminary research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2019.

It was found that older heart attack patients suffered more complications, such as shock and heart failure, had longer hospital stays and had an increased chance of death.

However, despite staying in the hospital on average a half-day longer, older patients had lower total charges, something the researchers said could be attributed to the lack of undergoing more costly interventions such as percutaneous coronary intervention, or PCI.

IMPACT

PCI, often referred to as angioplasty, is a non-surgical procedure used to treat narrow or blocked coronary arteries. During the procedure, special tubing with an attached deflated balloon is inserted into the blockage and the balloon is inflated to push open the blockage. Sometimes a stent may be placed during the procedure to keep the blood vessel open.

Researchers used the 2014 Nationwide Inpatient Sample to review records of 115,042 heart attack patients, 54 percent of whom were over 65.

The average age of the older group was 78. They were more likely than their younger counterparts to have high blood pressure, heart failure, chronic kidney disease and diabetes.

Compared to younger patients, older patients were found to be 34 percent less likely to receive PCI to open blocked arteries; 36 percent less likely to have a stent inserted to keep the artery open after the blockage is removed; and 34 percent less likely to have stents placed within 48 hours. There appeared to be no difference between the two groups in the use of drugs or surgery to open blocked arteries.

Older patients were more likely to fare worse. Compared to younger counterparts, they were 62 percent more likely to develop heart failure; 28 percent more likely to go into shock; 21 percent more likely to experience cardiac arrest; and 10 percent more likely to need assistance from a breathing machine.

Despite older patients having to stay in the hospital longer, their adjusted total hospital charges were lower by approximately $3,231 per stay compared to younger patients – possibly due to the decreased use of the expensive PCI procedure.

THE TREND

A program designed to help heart attack patients with the transition from hospital to outpatient care can reduce readmissions and deaths and increase the number of patients keeping follow-up appointments, a new study suggests.

Findings from the Sanger Heart and Vascular Heart Care Navigation Team study indicate the program is effective enough to make a statistically significant dent in readmissions, which in turn helps providers avoid reimbursement penalties, which the Centers for Medicare and Medicaid Services imposes based on readmissions and other metrics.

And since care quality generally improves, with fewer deaths reported, it has the potential to increase patient satisfaction, an important consideration in an increasingly consumer-driven industry.
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com

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