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A new long-term look at heart attack care and spending in America since the turn of the century shows more survival, more spending, and more variation between hospitals on both scores.

And while some of that spending -- on rapid angioplasty to open clogged heart arteries -- appears to be paying off, a lot of the dollars spent in the six months after a heart attack don't seem to be making much of a difference in the long-term death rate for patients.

The findings are published in JAMA Cardiology by a team led by members of the University of Michigan Institute for Healthcare Policy and Innovation and the Dartmouth Institute for Health Policy and Clinical Practice. The team analyzed data from nearly 480,000 people covered by traditional Medicare who were treated for acute myocardial infarction at 1,220 hospitals nationwide between 1999 and 2014.

The findings come out just a month after the federal government announced the cancellation of a "bundled payment" program that was supposed to incentivize better and more cost-effective care across all settings for the first three months after a heart attack.

Recent government programs to incentivize better heart attack care have focused on capping the total payment a hospital or health system can get for the first 30 days of post-heart attack care, and publicly reporting how hospitals stack up against others in heart attack deaths.

And indeed, the study shows, in the years since these programs rolled out, 30-day heart attack care spending has stayed flat while mortality has dropped.

Lead author Donald Likosky, Ph.D. of U-M's Department of Cardiac Surgery says, "while healthcare policies have resulted in little variation in 30-day hospital expenditures for heart attacks, they have had little impact on spending beyond 30 days. We see unwarranted variation in spending by hospitals beyond 30 days without much measurable benefit in mortality."

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