Despite Medicare expenditure growths between 1999 and 2014, reductions in acute myocardial infarction (MI) mortality varied by hospital and were associated with diffusion of cost-effective care, according to study findings published in JAMA Cardiology.

Researchers conducted a cross-sectional analysis of a random 20% sample of fee-for-service Medicare beneficiaries with acute MI who were admitted to 1220 hospitals from January 1, 1999, to December 31, 2000 (n=72,473) and from January 1, 2004, to December 31, 2004 (n=38,248). The researchers used a 100% sample of beneficiaries for January 1, 2008, to December 31, 2008 (n=159,558), and for January 1, 2013, to June 30, 2014 (n=209,614). The primary outcome for this analysis was the risk-adjusted 180-day case fatality rate.

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Per patient, adjusted healthcare expenditures rose 13.9% from January 1, 1999, to December 31, 2000, and January 1, 2013, to June 30, 2014. Despite this increase, there was a 0.5% decline in expenditures between 2008 and 2013 to 2014. Overall, average expenditures in 61 of the 1220 hospitals increased by 44.1% ($12,828) between 1999 to 2000 and 2013 to 2014.

During this same period, an expenditure decline of 18.7% was observed in the 61 hospitals with the slowest expenditure growth (−$7384; 95% CI, $8177-$6496). The rise in early percutaneous coronary intervention was inversely associated with 180-day mortality, even after controlling for additional measures of 180-day spending (β=−0.079; P <.001). A positive association was observed between spending on cardiac procedures and 180-day mortality, whereas spending on postacute care was associated with cost-effectiveness ($455,000 per life saved after 180 days; 95% CI, $323,000-$833,000).

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This study was limited to fee-for-service Medicare beneficiaries, and the findings may not be generalizable to other population groups. In addition, the researchers of this analysis did not account for all spending components, including pharmaceutical therapies and supplemental insurance bills.

In addition to reducing overall expenditures, the use of “interventions designed to promote hospital adoption of cost-effective care could improve patient outcomes” in the setting of acute MI.


Likosky DS, Van Parys J, Zhou W, et al. Association between Medicare expenditure growth and mortality rates in patients with acute myocardial infarction: a comparison from 1999 through 2014 [published online December 20, 2017]. JAMA Cardiol. doi: 10.1001/jamacardio.2017.4771