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Coronary heart disease in Massachusetts: the years of change (1980-1984)
J E Dalen1, R J Goldberg, D D'Arpa
1Department of Medicine, University of Massachusetts School of Medicine, Worcester.
Insights
Hospitalization for coronary heart disease (CHD) rose 17% in Massachusetts during the early 1980s. However, aggressive treatments like percutaneous transluminal coronary angioplasty (PTCA) led to a 16% decrease in CHD case fatality rates.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Coronary heart disease (CHD) diagnosis and treatment evolved significantly during the 1980s, becoming more aggressive.
- Understanding trends in hospitalization, treatment utilization, and outcomes is crucial for assessing healthcare effectiveness.
Purpose of the Study:
- To document hospitalization rates, treatment patterns, and case fatality for coronary heart disease (CHD) in Massachusetts.
- To analyze changes in the use of invasive procedures like coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG) for CHD during 1980-1984.
Main Methods:
- Utilized the Massachusetts Health Data Consortium (MHDC) database, encompassing 3.8 million hospital discharge records from 1980, 1982, 1983, and 1984.
- Focused on approximately 190,000 records categorized under chronic active coronary disease (CACD) and acute myocardial infarction (AMI).
- Analyzed trends in hospitalization rates, intervention frequencies, and case fatality rates.
Main Results:
- Total hospitalization rates for symptomatic CHD increased by 17%, driven by higher transfer rates and a larger patient cohort.
- The overall case fatality rate for hospitalized CHD decreased by approximately 16%, from 9.7% in 1980 to 8.1% in 1984.
- Interventional procedures saw significant increases: PTCA use grew substantially relative to CABG for CACD, and total interventions for AMI increased nearly twenty-fold from 1980 to 1984.
Conclusions:
- The early 1980s witnessed a shift towards more aggressive and invasive treatments for CHD in Massachusetts.
- Despite increased hospitalizations, advancements in interventions like PTCA contributed to improved survival rates for acute myocardial infarction (AMI) and chronic active coronary disease (CACD).
- Statewide mortality rates for hospitalized CHD remained stable, suggesting a complex interplay between treatment efficacy and disease burden.
Abstract:
During this decade, diagnosis and treatment of coronary heart disease (CHD) have become far more aggressive and invasive than in prior decades. This study documents rates of hospitalization, use of various treatment options, a case fatality in the state of Massachusetts during 4 of the first 5 years of this decade (1980, 1982, 1983, and 1984). The data base was that of the Massachusetts Health Data Consortium (MHDC), covering all hospital discharges in the state, a total of 3.8 million discharge records for this period. Of these, about 190,000 (5%) fell into two active symptomatic categories of CHD: chronic active coronary disease (CACD) and acute myocardial infarction (AMI). Total hospitalization rate for these CHD categories increased by 17%; this was due both to an increased rate of hospital transfers (or readmissions) and to a larger cohort of patients under care. The case fatality rate for hospitalized CHD decreased approximately 16%, from 9.7% (1980) to 8.1% (1984). In CACD the frequency of coronary angiography (CA) rose; the use of percutaneous transluminal coronary angioplasty (PTCA) increased much faster than the rate of coronary artery bypass grafting (CABG), with a resultant increase in PTCA as a fraction of total interventions. Similar findings were recorded for AMI, but with much more marked changes, the total intervention rate increasing almost twenty-fold from 1980 to 1984. The statewide mortality rate for hospitalized CHD patients remained essentially unchanged at 71 to 74 hospital deaths per 100,000 population.