Decline in acute MI, stroke hospitalizations among Medicare beneficiaries during pandemic
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During the COVID-19 pandemic, Medicare beneficiaries presented less frequently to hospitals for acute MI and stroke compared with 2018 and 2019, according to new research published in JAMA Cardiology.
“Hospitalizations for acute myocardial infarction and stroke declined nationwide among adults during the early COVID-19 period, suggesting some patients did not receive timely care for these emergencies. Declines in acute MI and stroke hospitalization might be particularly large for Medicare patients who, because they are older or physically disabled and have more comorbidities, are both more likely to have cardiovascular events and have concerns about contracting COVID-19 during a hospitalization,” Kate A. Stewart, PhD, senior researcher at Mathematica Policy Research in Princeton, New Jersey, and colleagues wrote. “However, to our knowledge, no studies have examined this population specifically to date.”
Researchers identified beneficiaries enrolled in Medicare fee-for-service since 2018 and analyzed hospital use for acute MI and stroke in 2020 compared with 2018 and 2019.
In 2018 and 2019, there were an average of 43 hospitalizations, outpatient ED visits or observation stays for acute MI and stroke per 100,000 beneficiaries. Compared with 2018 and 2019, the researchers reported a 14% decline in hospital use for acute MI and stroke in 2020. From March 11 to April 7, 2020, there was a 32% decline in hospital use for acute MI and stroke. After April 7 and through week 25, acute MI and stroke hospital use increased closer to levels in 2018 and 2019. However, weekly hospitalization rates in 2020 remained, on average, 12% lower between weeks 26 and 52 compared with the same period in 2018 and 2019, the researchers wrote.
The decline and later recovery in hospital use for acute MI and stroke were similar across subgroups. Patients with six or more chronic conditions had the greatest decline in hospital use for acute MI and stroke (42% decrease). Patients with at least six chronic conditions also had the highest rate of hospital use for acute MI and stroke in 2018 and 2019 (71 per 100,000 beneficiaries).
According to the researchers, the decline in hospital use for acute MI and stroke in 2020 may be attributable to:
- fewer acute MIs and strokes in 2020 compared with 2018 and 2019, possibly due to pandemic-related policies and behavior changes;
- fear of COVID-19 infection outweighing benefits of seeking emergency care for acute MI or stroke; and
- COVID-19-related mortality that lowered the average risk for acute MI or stroke at the population-level for Medicare beneficiaries.
“Understanding the extent to which each of these factors contributed to reductions in hospital use for acute MI and stroke will be important for future medical and public health advancements in care for patients with acute MI and stroke,” the researchers wrote.
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