Changing Trends in the Landscape of Patients Hospitalized With Acute Myocardial Infarction (2001 to 2011) (from the Worcester Heart Attack Study)

Abstract

During the past several decades, new diagnostic tools, interventional approaches, and population-wide changes in the major coronary risk factors have taken place. However, few studies have examined relatively recent trends in the demographic characteristics, clinical profile, and the short-term outcomes of patients hospitalized for acute myocardial infarction (AMI) from the more generalizable perspective of a population-based investigation. We examined decade long trends (2001 to 2011) in patient's demographic and clinical characteristics, treatment practices, and hospital outcomes among residents of the Worcester metropolitan area hospitalized with an initial AMI (n = 3,730) at all 11 greater Worcester medical centers during . The average age of the study population was 68.5 years and 56.9% were men. Patients hospitalized with a first AMI during the most recent study years were significantly younger (mean age = 69.9 years in 2001/2003; 65.2 years in 2009/2011), had lower serum troponin levels, and experienced a shorter hospital stay compared with patients hospitalized during the earliest study years. Hospitalized patients were more likely to received evidence-based medical management practices over the decade long period under study. Multivariable-adjusted regression models showed a considerable decline over time in the hospital death rate and a significant reduction in the proportion of patients who developed atrial fibrillation, heart failure, and ventricular fibrillation during their acute hospitalization. These results highlight the changing nature of patients hospitalized with an incident AMI, and reinforce the need for surveillance of AMI at the community level. © 2019 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http:// creativecommons.org/licenses/by-nc-nd/4.0/) (Am J Cardiol 2020;125:673−677)Despite significant advances in patient management and population-wide lifestyle changes in several predisposing factors, acute myocardial infarction (AMI) continues to be a major cause of morbidity and mortality in the United States. 1,2 A limited number of community-based studies have described changes over time in the clinical epidemiology and outcomes of patients hospitalized with AMI in the United States. 3 These studies include the Worcester Heart Attack Study, the Minnesota Heart Survey, and Rochester Epidemiology Project. 4−12 However, few relatively recent data exist describing the potentially changing landscape of AMI at the community level. The primary objective of this population-based study was to describe decade long trends in the demographic and clinical characteristics, hospital management practices, and in-hospital clinical outcomes among residents of central Massachusetts hospitalized with a first AMI at all 11 metropolitan Worcester medical centers on a biennial basis between 2001 and 2011. MethodsDetails of the Worcester Heart Attack Study have been previously described. 4−7 In brief, residents of the Worcester metropolitan area hospital...

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