IMPACT OF HEALTHCARE ORGANIZATIONAL CHANGES ON CARDIOVASCULAR DISEASE HOSPITALIZATIONS IN KAZAKHSTAN

ABSTRACT

Cardiovascular diseases (CVD) remain the leading cause of death. An analysis of hospitalizations from 2020 to 2024 showed a peak in 2023 among young patients (18–44 years), especially men, likely due to increased detection and changes in healthcare organization. In 2024, hospitalizations declined, possibly due to administrative reforms. In the 45–64 age group, heart failure and hypertension cases increased, while other conditions, such as arrhythmias, remained stable or declined, suggesting more effective prevention and outpatient care. Patients aged 65+ continue to place a high burden on the healthcare system, particularly due to coronary heart disease and atrial fibrillation. The rise in aortic aneurysms highlights the need for improved diagnostics. These findings emphasize the importance of prevention, gender-sensitive strategies, and better control of chronic diseases.

АННОТАЦИЯ

Сердечно-сосудистые заболевания (ССЗ) остаются ведущей причиной смерти. Анализ госпитализаций за 2020–2024 годы выявил пик в 2023 году среди молодых пациентов (18–44 лет), особенно мужчин, что может быть связано с ростом выявляемости и изменениями в организации медпомощи. В 2024 году госпитализации снизились, вероятно, из-за новых административных мер. В группе 45–64 лет отмечается рост сердечной недостаточности и гипертонии при снижении или стабильности других диагнозов, что может указывать на эффективность профилактики. У пожилых пациентов (65+) сохраняется высокая нагрузка на систему здравоохранения, особенно по ишемической болезни сердца и фибрилляции предсердий. Рост аневризм аорты подчеркивает необходимость усиления диагностики. Выводы подчеркивают важность профилактики, гендерно-ориентированных подходов и улучшения контроля хронических заболеваний.

Keywords: Cardiovascular diseases (CVD), prevention, chronic diseases, hospitalization, organization of medical care.

Ключевые слова: Сердечно-сосудистые заболевания (ССЗ), профилактика, хронические заболевания, госпитализация, организация медпомощи.

Introduction

The cardiovascular system includes the heart and blood vessels that transport oxygen, nutrients, and waste throughout the body. It plays an important role in maintaining overall health by ensuring adequate blood flow to all organs and tissues. Cardiovascular diseases (CVD) cover a wide range of conditions, including coronary artery disease, cerebrovascular disease, peripheral arterial disease, and aortic atherosclerosis. These conditions can lead to serious complications, such as myocardial infarction, stroke, and limb ischemia [20].

The AHA 2025 update shows positive trends in physical activity, reduced nicotine use, and better sleep. However, diet quality remains poor, especially among adolescents, with an average healthy eating score of just 28.5/100. In 2019, diet-related factors caused 7.9 million deaths in the U.S. Life expectancy is closely tied to cardiovascular health but has declined nationally from 78.8 to 76.1 years between 2019 and 2021. Traditional smoking is down in youth, but e-cigarette use has risen, and racial disparities in smoking rates persist. Only 20.5% of children meet daily activity guidelines, highlighting continued challenges in health behavior [1-3, 5, 12-14, 16, 19, 21].

The British Heart foundation reports a major decline in CVD deaths—from 1,045 per 100,000 in 1969 to 255 in 2019—thanks to preventive care. However, progress has slowed due to rising obesity and diabetes. CVD still causes over 1.18 million hospital admissions and £19 billion in economic losses annually. Regional disparities, especially higher mortality in Scotland, persist. More robust data and research on socioeconomic factors are urgently needed. Across Asia, heart failure (HF) has seen mixed trends between 1990 and 2019. In some countries, such as Timor-Leste (9.4%), Indonesia (7.83%) and the Philippines (7.6%), age-standardized rates have increased significantly, while they have decreased in Singapore, Japan and Kazakhstan. In China, the incidence of HF was 275 cases per 100,000 person-years in 2017. In India, between 491,600 and 1.8 million new cases of HF are registered annually. The main risk factors remain hypertension and coronary heart disease. Environmental factors such as air pollution and temperature changes also have a significant impact. Mortality from HF varies significantly: according to the INTER-CHF study, the annual mortality rate was 23% in India, 15% in Southeast Asia and 7% in China [4, 7-10, 18]. In Kazakhstan, a decrease in both overall and avoidable mortality from diseases of the circulatory system was recorded from 2011 to 2021 [11]. This was achieved thanks to policies to ensure universal access to health care, strengthen primary health care, and implement programs for the early detection and management of chronic diseases. For example, 75% of patients with hypertension who participated in the programs achieved blood pressure stabilization.

However, the level of avoidable mortality from CVD remains high compared to developed countries, especially due to the prevalence of coronary heart disease and stroke. Men demonstrate higher mortality, which may be due to lifestyle and low levels of health literacy. The COVID-19 pandemic has also negatively affected the system of care for chronic patients. Current challenges include insufficient public awareness of risk factors, poor adherence to treatment, and a lack of medical resources in rural areas. Improving the health literacy of the population, as well as the introduction of gender-oriented approaches in primary health care are necessary conditions for further progress in the fight against cardiovascular diseases in the country. A key aspect of solving these problems is a detailed analysis of hospitalized patients, taking into account factors such as age, gender, access to medical care and treatment costs. The aim of our study is to analyze the dynamics of hospitalizations and treatment outcomes for cardiac diseases by age, gender and region in 2020-2024.

Materials and methods

A retrospective cohort study was conducted using clinical and administrative data from patients hospitalized with ICD-10 cardiovascular disease diagnoses (I00–I99) between 2020 and 2024. The data were stratified by age groups according to WHO classifications (18–44, 45–64, and 65+ years) and by gender. Statistical analysis was performed using Microsoft Excel and IBM SPSS Statistics (version 26). The analysis focused on identifying patterns in clinical outcomes and healthcare delivery by calculating absolute and relative changes across the stratified groups.

Results and discussions

The table 1 presents an analysis of treated cases of diseases among young patients (18–44 years) in one of the hospitals for the period 2020–2024 revealed wave-like dynamics with a pronounced peak in 2023 and a noticeable decrease in 2024. The increase in the number of hospitalizations in 2023 affected both men and women, mainly due to cardiovascular diseases such as heart failure, arrhythmia, angina pectoris, and valvular heart defects. This may be due to both increased detection of diseases and organizational and structural changes, including priority hospitalization of cardiac patients. The sharp decrease in the number of treated cases in 2024, on the contrary, is likely due to administrative and logistical factors: redistribution of patient flows, changes in routing, limitation of hospital beds, or the transition of some cardiac cases to the outpatient segment. In men, the most pronounced increase in 2023 was recorded for diagnoses such as heart failure (I50), mitral valve defects (I34), angina (I20), and hypertension with heart disease (I11). A particularly sharp increase occurred for I50 - from 3 cases in 2022 to 30 in 2023. However, already in 2024, the number of hospitalizations in these areas decreased by almost four times. When comparing 2020 and 2024, it is clear that some diagnoses remain stable or show moderate growth: for example, the number of cases for heart failure (I50) increased from 4 to 7 (+ 75%), and for mitral valve defect (I34) - from 6 to 7 (+ 16.7%). At the same time, for such nosologies as arrhythmia (I47), a complete disappearance of hospitalizations was recorded (from 7 to 0), which may be due to a change in patient management tactics or a decrease in the availability of specialized diagnostics. Among women, the dynamics were more contrasting: despite an increase in the number of treated cases in 2023 for such nosologies as paroxysmal tachycardia (I47), heart failure (I50), valve defects (I34, I36) and hypertension (I11), by 2024 almost all of these indicators had sharply decreased. A comparison of 2020 and 2024 shows a significant decrease in hospitalizations for most diagnoses: arrhythmia (I47) - from 25 to 0 cases (-100%), hypertension (I11) - from 7 to 0, angina (I20) - from 6 to 2. The only exception is heart failure (I50), for which a slight increase was recorded - from 5 to 6 cases (+ 20%). Such dynamics may indicate a shift in emphasis towards outpatient monitoring or a decrease in the availability of hospitalization for this group.

In general, over the five-year period, there is a tendency towards a decrease in the number of hospitalizations among young women for major cardiovascular diseases. In men, on the contrary, the dynamics are more stable, with a moderate increase for a number of severe nosologies. These results emphasize the need for further monitoring of patient routing and a revision of the inpatient care strategy to ensure equal access to treatment and diagnostics.

Table 1.

 Absolute and relative change in treated cases according to ICD-10 in men and women (2020 -2024) in the age group 18-44 years

The table 2 shows changes in diagnoses for men and women aged 45-64 years for the period from 2020 to 2024. Absolute changes indicate the difference in the number of cases between the two years, and relative changes show the percentage change (positive or negative). An analysis of changes in hospitalizations by diagnosis in the 45-64 age group from 2020 to 2024 highlights several key trends that can be explained by both changes in treatment and diagnostic approaches and in preventive measures.

One of the most notable trends is a decrease in the number of hospitalizations for hypertension with heart disease (I05). During this period, the number of hospitalizations among men decreased by 11 cases (−84.6%), and among women by 23 cases (−79.3%). This may indicate a significant improvement in the prevention and treatment of hypertension, as well as optimization of approaches to the treatment of cardiovascular diseases in this group of patients.

Angina (I20) also shows a decrease in hospitalizations, both among men (−238 cases or −30.3%) and women (−72 cases or −25.4%). These data may indicate improved patient control and more effective treatment of angina, which reduces the need for emergency hospitalizations and reduces morbidity in this group. In parallel, there is a decrease in hospitalizations for other diagnoses related to coronary heart disease, such as myocardial infarction (I21), which also confirms improved treatment outcomes. On the other hand, there is an increase in the number of hospitalizations for some diagnoses, such as mitral valve defects (I34), where the number of cases in men increased from 6 to 7, and in women decreased from 3 to 2. This may indicate that against the background of a decrease in the number of hospitalizations for some cardiovascular diseases, for example, angina or heart failure, the detection of other diseases, such as valve defects, is increasing. In addition, a sharp decrease in the number of hospitalizations for the diagnoses of paroxysmal tachycardia (I47) and heart failure (I50) in men and women (including -100% in women for I47) may indicate a significant improvement in the treatment of arrhythmias and heart failure, as well as more effective prevention and control of these diseases in this age group. A decrease in hospitalizations for these diagnoses indicates the success of modern methods of treatment and prevention, which helps reduce morbidity and prevent emergency cases.

Table 2.

 Absolute and relative change in treated cases according to ICD-10 in men and women (2020 - 2024) in the age group 45-64 years

An analysis of visits from patients over 65 years of age with cardiovascular diseases for 2020–2024 shows a persistently high burden on the healthcare system. The most common causes of hospitalization were coronary heart disease (I20), atrial fibrillation (I48), other rhythm disorders (I49), and heart failure (I50). For example, the number of patients with coronary heart disease (I20) consistently exceeded 1,000 cases per year, reaching a maximum in 2023 (1,566 cases). A significant increase was also observed in heart failure: from 60 cases in 2020 to 184 in 2023, with men being hospitalized for this diagnosis 3–4 times more often than women. Heart valve pathologies made a significant contribution to the morbidity structure. The most frequently recorded non-rheumatic lesions were the mitral (I34) and aortic valves (I35), totaling dozens of cases annually — up to 81 cases for I34 and up to 64 for I35 in some years. Visits for multiple valve defects (I08) and rheumatic forms (I05–I07) also persist, especially in women, indicating the continuing clinical significance of these forms even in old age. A number of less frequent diseases, but clinically significant diagnoses, such as aortic aneurysms (I71), pulmonary vascular aneurysms (I27), heart block (I44–I45), and vascular pathologies (I70–I73), also show certain dynamics. The increase in cases of aortic aneurysm in 2023–2024 is particularly notable (8 and 4 cases, respectively), which requires enhanced diagnostics and prevention. Some diagnoses, such as I10 (hypertension), I24 (other forms of acute ischemia) and I26 (pulmonary embolism), were detected sporadically, but potentially pose a high risk.

It is worth noting the sharp decrease in the number of cases for almost all diagnoses in 2024, which is probably not due to a real improvement in the situation, but to a change in the procedure for recording, routing patients or administrative measures. The overall picture indicates a high need for systemic prevention, screening for coronary heart disease and rhythm disorders, especially in elderly men, as well as the need for accurate monitoring and analysis of the causes of sharp fluctuations in statistics.

Between 2020 and 2024, a number of changes in the incidence of patients over 65 years of age are observed. For example, in men, an increase in the number of cases of coronary heart disease (I20) by 10% was recorded, while in women a decrease of 11.6% was observed. This may be due to differences in the frequency and severity of clinical presentations of diseases in men and women. A decrease in the number of cases of atrial fibrillation (I48) and other rhythm disorders (I49) was also noted in both sexes, which may indicate changes in patient routing or reorganization of treatment approaches.

Particular attention should be paid to the dynamics of valvular diseases. In men, there is a decrease in visits for aortic valve defects (I35) by 48.7%, while in women there is an increase in this disease by 35%. In women, the number of cases of multiple valve defects (I08) also increased by 40%, which may indicate better diagnostic results or a change in morbidity trends in the older age group. While cases of heart failure (I50) have significantly decreased in both sexes, which may be due to improved outpatient monitoring or changes in hospitalization. There is also an increase in cases of aortic aneurysm (I71) among older patients, especially in women, where the rate increased from 0 to 2 cases, which calls attention to the need for early detection and screening of this disease in the elderly. At the same time, the total number of visits for heart disease in men remains stable or decreases at a moderate rate, which may reflect a change in clinical practices or demographic factors.

Overall, the data indicate a changing pattern of morbidity among the elderly, with men maintaining stability in some diseases, and women showing a downward trend in hospitalizations for a number of cardiovascular diseases. This may be due to both improved prevention and diagnosis, and changes in organizational approaches to the treatment of the older age group.

Table 3.

Absolute and relative change in treated cases according to ICD-10 in men and women (2020 - 2024) in the age group over 65 years

Note: ∞% means that in 2020 the value was 0 and any positive change cannot be expressed as a percentage correctly.

The data show a steady increase in the number of cardiac surgeries among patients over 65 years of age, while in younger age groups there is a wave-like trend with a noticeable peak in 2023. These changes may be due to the epidemiological situation, changes in healthcare organization, as well as improved diagnostics and prevention of cardiovascular diseases. It is important to continue monitoring the cardiac surgical workload, as well as to analyze possible factors influencing changes in the number of hospitalizations.

Conclusion

Cardiovascular diseases (CVDs) continue to pose a serious health and economic challenge, disproportionately affecting different age and gender groups. Despite some advancements in detection and care, high preventable mortality—especially in rural and underserved populations—reflects ongoing disparities in healthcare access and outcomes. The rise in hospitalizations among young adults, the complex disease dynamics in the middle-aged population, and the sustained burden in older adults highlight the need for more adaptive, life-stage-specific, and gender-sensitive approaches. The findings underscore the importance of not only improving medical infrastructure and diagnostics but also addressing underlying risk factors such as obesity, smoking, and diabetes through public health initiatives. A multi-level strategy should be adopted that includes strengthening early preventive interventions across all age groups, with particular emphasis on the younger population to reverse rising trends in CVD hospitalizations. This should be supported by public education campaigns to raise awareness, improved access to screening and outpatient care, and the integration of gender-responsive and socially inclusive health policies. Investing in modern diagnostic technologies, especially for older adults, and enhancing chronic disease management systems will be essential to reduce long-term hospitalization rates and improve population health outcomes [6, 15, 17, 22-23].

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