No pain, but no gain? The disappearance of angina hospitalizations, 1992-1999

UMMS Affiliation

Meyers Primary Care Institute; Department of Family Medicine and Community Health

Publication Date


Document Type



Aged; Angina Pectoris; Data Collection; Female; Health Services Research; Hospitalization; Humans; Male; Medicare; Patient Discharge; Quality Indicators, Health Care; United States


Health Services Research | Primary Care


BACKGROUND: Hospitalization for angina is commonly considered an ambulatory care sensitive hospitalization and used as a measure of access to primary care.

OBJECTIVE: To analyze time trends in angina-related hospitalizations and seek possible explanations for an observed, marked decline during 1992 to 1999.

RESEARCH DESIGN: We analyzed Medicare claims of SEER-Medicare control subjects for occurrence of angina hospital discharges, using the Agency for Healthcare Research and Quality Prevention Quality Indicator (PQI) definition, along with occurrence of related events including angina admissions with revascularization, angina admissions discharged as coronary artery disease (CAD) or myocardial infarction, and overall ischemic heart disease discharges.

SUBJECTS: Approximately 124,000 cancer-free Medicare beneficiary/ies, with subjects contributing data for 1 to 8 years.

RESULTS: Angina PQI hospital discharges declined 75% between 1992 and 1999. CAD hospital discharges rose in a reciprocal pattern, while angina discharges with revascularization declined and discharges for myocardial infarction and ischemic heart disease were relatively constant during this time period.

CONCLUSIONS: The marked decline in angina PQI hospital discharges during 1992-1999 does not appear to represent improvements in access to care or prevention of heart disease, but rather increased coding of more specific discharge diagnoses for CAD. Our findings suggest that angina hospitalization is not a valid measure for monitoring access to care and, more generally, demonstrate the need for careful, periodic re-evaluation of quality measures.

DOI of Published Version



Med Care. 2009 Oct;47(10):1106-10. Link to article on publisher's site

Journal/Book/Conference Title

Medical care

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Link to Article in PubMed

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