AHRQ Study Finds Decline in Adverse Events for Heart Attack, Heart Failure Patients
Adverse events for patients being treated for heart attack and heart failure have declined, according to a new study published in the January 23 issue of the New England Journal of Medicine (NEJM). However, theAHRQ-funded analysis used to develop the NEJM study found no significant decrease in adverse events for patients being treated for pneumonia and those who received surgery. The study, “National Trends in Patient Safety for Four Common Conditions, 2005 to 2011,” compared the rate of 21 adverse events that occurred among hospital patients in 2005-2006 with those that happened in 2010-2011. Researchers from AHRQ and the Harvard School of Public Health’s Department of Biostatistics found that from 2005 to 2011, the rate of heart attack patients experiencing one or more adverse events fell from 26.0 percent to 19.4 percent and the rate for heart failure patients experiencing adverse events fell from 17.5 percent to 14.2 percent. A preview of the study is available on the NEJM Web site.
National Trends in Patient Safety for Four Common Conditions, 2005–2011
N Engl J Med 2014; 370:341-351January 23, 2014DOI: 10.1056/NEJMsa1300991
BACKGROUNDChanges in adverse-event rates among Medicare patients with common medical conditions and conditions requiring surgery remain largely unknown.
METHODSWe used Medicare Patient Safety Monitoring System data abstracted from medical records on 21 adverse events in patients hospitalized in the United States between 2005 and 2011 for acute myocardial infarction, congestive heart failure, pneumonia, or conditions requiring surgery. We estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations.
RESULTSThe study included 61,523 patients hospitalized for acute myocardial infarction (19%), congestive heart failure (25%), pneumonia (30%), and conditions requiring surgery (27%). From 2005 through 2011, among patients with acute myocardial infarction, the rate of occurrence of adverse events declined from 5.0% to 3.7% (difference, 1.3 percentage points; 95% confidence interval [CI], 0.7 to 1.9), the proportion of patients with one or more adverse events declined from 26.0% to 19.4% (difference, 6.6 percentage points; 95% CI, 3.3 to 10.2), and the number of adverse events per 1000 hospitalizations declined from 401.9 to 262.2 (difference, 139.7; 95% CI, 90.6 to 189.0). Among patients with congestive heart failure, the rate of occurrence of adverse events declined from 3.7% to 2.7% (difference, 1.0 percentage points; 95% CI, 0.5 to 1.4), the proportion of patients with one or more adverse events declined from 17.5% to 14.2% (difference, 3.3 percentage points; 95% CI, 1.0 to 5.5), and the number of adverse events per 1000 hospitalizations declined from 235.2 to 166.9 (difference, 68.3; 95% CI, 39.9 to 96.7). Patients with pneumonia and those with conditions requiring surgery had no significant declines in adverse-event rates.
CONCLUSIONSFrom 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. (Funded by the Agency for Healthcare Research and Quality and others.)
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