Studies Of More Than 25,000 Emory Angioplasty And Coronary Bypass Patients Reveal Improvement In Patient Outcomes; Decrease In Cost

November 11, 1997

ORLANDO -- Sicker heart patients are more likely to survive coronary intervention, are spending less time in the hospital recovering and are doing better once at home -- all this at about one-third the cost of similar care in the 1980s, according to cost benefit analyses presented by Emory University's William S. Weintraub, M.D., at this week's American Heart Association 70th Scientific Sessions.

Dr. Weintraub and his Emory colleagues profiled all 12,265 patients who underwent coronary artery bypass graft surgery at Emory University hospitals from 1988-96 as well as all 12,978 patients who received balloon angioplasty at Emory from 1991-96. While the numbers of the two analyses differ, the trends uncovered do not.

"Thus over time there have been better results on sicker (and probably more appropriate) patients," Dr. Weintraub says in his presentation, Have Coronary Surgical Services Been Optimized? "This was accomplished while also shortening length of stay and dramatically cutting costs."

In the coronary bypass surgery analysis, the researchers report that hospital costs in 1996 dollars fell 30 percent (from mean per-procedure costs of $22,689 in 1988 to $15,987 in 1996). Other statistically significant changes noted during that time period indicate that patients are older (from a mean age of 62 in 1988 to age 63 in 1996) and are more likely to have high blood pressure (53 to 67 percent), to have had a heart attack (51 to 58 percent), to have diabetes (20 percent to 33 percent) and to have had congestive heart failure (6.5 to 7.9 percent). Death rates in the study population decreased from 4.7 to 2.7 percent, reflecting a two percent decrease in mortality in 1996 corrected to a 1988 patient population.

"Whether these trends will continue and whether these changes will prove to be sufficient in the increasingly difficult current environment remains to be seen," says Dr. Weintraub, who is associate professor of Medicine (Cardiology), Emory University School of Medicine, and a faculty member in the Center for Clinical Evaluation Sciences at Emory's Rollins School of Public Health.

In the balloon angioplasty analysis Trends in Outcome and Cost of Coronary Intervention in the 1990s, the Emory team reports a 26 percent decrease in per-procedure costs (from $9,412 in 1991 to $6,978 in 1996) and an increase in angioplasty success from 93 percent in 1991 to 96 percent in 1996. Use of stents to augment angioplasty increased from 5.4 to 30.4 percent usage. And as in the bypass cohort, angioplasty patients seen in 1996 tended to be older (from 61 in 1988 to 62), to have high blood pressure (52 to 60 percent), to have diabetes (21 to 26 percent) and to have had congestive heart failure (5.8 to 6.4 percent). Fewer had undergone previous coronary bypass surgery (2.7 to 1.4 percent). All these trends were statistically significant.

"Over that last several years the patients have become sicker and by several measures outcome has improved," Dr. Weintraub reports. "These changes have been accomplished while at the same time resource use has decreased as measured by length of stay (down from 2.8 days in 1991 to 1.9 days in 1996) and cost. The decrease in cost was 26 percent, almost entirely in the last two years while stent utilization increased. Whether these favorable trends can continue or if care is already optimal remains to be seen."
Have Coronary Surgical Services Been Optimized?
(Abstract 414)
Oral Presentation: Sunday, Nov. 9, 1997, 4:45 p.m., E.S.T.
William S. Weintraub, Joseph M. Craver, John P. Gott,
Steven D. Culler, Robert A. Guyton, Emory University

Trends in Outcome and Costs of Coronary Intervention in the 1990s
(Abstract 314A)
Oral Presentation: Tuesday, Nov. 11, 1997, 4:15 p.m., E.S.T.
William S. Weintraub, Ziyad M.B. Ghazzal, John S. Douglas Jr.,
Steven D. Culler, Spencer B. King III, Emory Unviersity

Emory University Health Sciences Center

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