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Hospital Use for Myocardial Infarction and Stroke Among Medicare Beneficiaries From March to December 2020

Educational Objective
To identify the key insights or developments described in this article

Hospitalizations for acute myocardial infarction (AMI) and stroke declined nationwide among adults during the early COVID-19 period, suggesting some patients did not receive timely care for these emergencies.14 Declines in AMI and stroke hospitalizations 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. However, to our knowledge, no studies have examined this population specifically to date. We compared weekly rates of hospital use for AMI and stroke in 2020 with weekly rates in 2018 and 2019 among Medicare fee-for-service (FFS) beneficiaries nationally.

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Article Information

Accepted for Publication: May 26, 2021.

Published Online: August 4, 2021. doi:10.1001/jamacardio.2021.2729

Corresponding Author: Kate A. Stewart, PhD, SM, Mathematica, 111 E Wacker Dr, Ste 3000, Chicago, IL 60601 (kstewart@mathematica-mpr.com).

Author Contributions: Dr Stewart and Ms Nelson had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Stewart, Blue, Kranker, McCall, Markovich, Peterson.

Acquisition, analysis, or interpretation of data: Stewart, Blue, Kranker, Nelson.

Drafting of the manuscript: Stewart, Nelson, Peterson.

Critical revision of the manuscript for important intellectual content: Blue, Kranker, McCall, Markovich.

Statistical analysis: Stewart, Nelson, Peterson.

Obtained funding: McCall, Peterson.

Administrative, technical, or material support: Blue, Kranker, Markovich.

Study supervision: McCall, Peterson.

Conflict of Interest Disclosures: None reported.

Funding/Support: The study was funded by contract HHSM-500-2014-00034I from the US Center for Medicare & Medicaid Innovation.

Role of Funder/Sponsor: The US Centers for Medicare & Medicaid Services (CMS) reviewed and approved the manuscript for submission through a standard CMS communications clearance process and supported the decision to submit the manuscript for publication. CMS had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of the manuscript.

Disclaimer: The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services or any of its agencies.

Additional Contributions: We acknowledge the important contribution made by Lei Rao, MS, formerly of Mathematica, who skillfully processed the Medicare claims and enrollment data for this study. She was compensated for her work.

References
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Birkmeyer  JD , Barnato  A , Birkmeyer  N , Bessler  R , Skinner  J .  The impact of the COVID-19 pandemic on hospital admissions in the United States: study examines trends in US hospital admissions during the COVID-19 pandemic.   Health Aff. 2020;39(11):2010-2017. doi:10.1377/hlthaff.2020.00980Google ScholarCrossref
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Blecker  S , Jones  SA , Petrilli  CM ,  et al.  Hospitalizations for chronic disease and acute conditions in the time of COVID-19.   JAMA Intern Med. 2021;181(2):269-271.PubMedGoogle ScholarCrossref
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Solomon  MD , McNulty  EJ , Rana  JS ,  et al.  The COVID-19 pandemic and the incidence of acute myocardial infarction.   N Engl J Med. 2020;383(7):691-693. doi:10.1056/NEJMc2015630PubMedGoogle ScholarCrossref
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McManus  DD , Nguyen  HL , Saczynski  JS , Tisminetzky  M , Bourell  P , Goldberg  RJ .  Multiple cardiovascular comorbidities and acute myocardial infarction: temporal trends (1990-2007) and impact on death rates at 30 days and 1 year.   Clin Epidemiol. 2012;4:115-123. doi:10.2147/CLEP.S30883PubMedGoogle Scholar
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Shah  A , Cicchiello  A , Cao  SY , Grace  S , Jacobsen  G , Schneider  EC . How has Medicare spending changed during the COVID-19 pandemic? Accessed May 25,2021. https://www.commonwealthfund.org/blog/2021/how-has-medicare-spending-changed-during-covid-19-pandemic
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