More Medicare dollars spent on treatment of a heart attack patient doesn't lead to better health outcomes, according to a new study.
A JAMA study published Wednesday found that mortality rates stayed constant for heart attack patients up to 180 days after discharge even as spending on cardiac procedures and post-acute care rose. But the study did find mortality dropped among patients who received early percutaneous coronary intervention, also known as angioplasty with a stent.
"The assumption to use more resources (to improve health outcomes for heart attack patients) might not be the case, but it might be more important where you spend the money on," said Donald Likosky, lead author of the study and cardiovascular epidemiologist at the University of Michigan.
Likosky and his co-authors looked at 479,893 Medicare beneficiaries hospitalized for heart attacks from 1999 to 2014.
They found 180-day mortality rates for patients declined from 26.9% in 1999 to 21.5% in 2014. Most of the decline happened in the initial 30 days after hospitalization and mortality rates were mostly unchanged from 31 to 180 days after a heart attack.
At the same time, spending per patient up to 180 days after a heart attack rose by nearly 14% from 1999 to 2014. Most of the spending increase occurred after 30 days in outpatient services, skilled-nursing facilities or home health. Yet, the study didn't find these additional services had an impact on mortality rates.
The study also noted there is wide variation in Medicare spending among hospitals for heart attack patients. The spend growth rate for about 61 hospitals, or 5% of total hospitals, rose by 44.1% while another 5% of hospitals decreased spending by 18.7%.
But the hospitals with rapid increases in spending did not experience higher mortality rate drops, the study said.
Likosky said he hopes the findings will be presented to providers and hospitals so they can rethink how they treat patients.