National Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010

Chaudhry, Sarwat I.; Khan, Rabeea F.; Chen, Jersey; Dharmarajan, Kumar; Dodson, John A.; Masoudi, Frederick A.; Wang, Yun; Krumholz, Harlan M.

doi:10.1161/jaha.114.001197

Cited by 51 publications

(44 citation statements)

References 40 publications

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“…In some studies, HIV-positive individuals have previously been found to have a higher rate of recurrent MIs and to more frequently undergo urgent angioplasties [18,28,35,36,37]. The proportion of recurrent MIs in the study was 11.6%; which is higher compared with previous findings from the general population (8.9% in 2010) [38]. We were unable to systematically evaluate the type of MI and degree of vessel disease, but the relatively young median age of the study participants at the time of MI may indicate that a higher proportion may have had a ST-elevated myocardial infarction (STEMI), as an inverse relationship has been demonstrated in men in the general population between age and the likelihood of the MI being a STEMI [39].…”

Section: Discussioncontrasting

confidence: 60%

Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals

Hatleberg

Ryom

El‐Sadr

et al. 2016

Aids

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OBJECTIVE Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen. DESIGN Prospective cohort study. METHODS Demographic, cardiovascular disease (CVD)/HIVrelated characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. RESULTS One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)]. CONCLUSION Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions. Design: Prospective cohort study.Methods: Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. Conclusion: Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.

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Section: Discussioncontrasting

confidence: 60%

Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals

Hatleberg

Ryom

El‐Sadr

et al. 2016

Aids

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“…These high all‐cause death rates may reflect the advanced age, history of CVD, and prevalence of comorbid conditions in the study population and are relatively consistent with other studies in similar populations. For example, 1‐year all‐cause mortality rates (2010) for Medicare patients who experienced a recurrent MI or stroke within 1 year of hospitalization for MI were 30% for patients with recurrent MI, 35% for those with IS following MI, and 61% for those with hemorrhagic stroke following MI . In another study of MI survivors at least 65 years old who subsequently died within 3 years of follow‐up, >50% of the deaths were attributed specifically to CVD .…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

Peng

Wang

et al. 2019

Clinical Cardiology

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Background Survivors of myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular events. Hypothesis Older patients with prior MI or IS are at risk for recurrent cardiovascular events, and comorbidities such as diabetes may increase this risk. Methods Two cohorts were studied in a retrospective Medicare 20% random sample—a 2008 cohort with up to 6 years of follow‐up (MI, N = 26 460; IS, N = 17 566) and a 2012 cohort with 1 year of follow‐up (MI, N = 26 548; IS, N = 17 728). Results In older patients who survived an event of MI or IS (2012 cohort), 7.2% had a recurrent MI and 6.7% had a recurrent IS in the first year; 32% died. Accounting for multiple recurrent events (2012 cohort), the event rates per 100 patient‐years were 11.6 and 10.2 for the MI and IS cohorts, respectively. Cumulative incidence of recurrence (2008 cohort) increased from 7.7% at 1 year to 14.3% at 6 years for recurrent MI and from 6.7% at 1 year to 13.4% at 6 years for recurrent IS. Comorbid diabetes (2012 cohort) was significantly associated (adjusted risk ratio) with MI recurrence (1.44) and risk of coronary revascularization (1.23) in the MI cohort and with IS recurrence (1.26) in the IS cohort. Conclusion In this older population with prior MI or IS, high rates of recurrent cardiovascular events and multiple recurrent events were observed. These findings highlight the need for aggressive intervention for secondary prevention and management of comorbidities in high‐risk patients, particularly those with diabetes.

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“…Despite these across-the-board improvements, the proportional decline in recurrent AMI rehospitalization was larger in whites (27.7%) than in blacks (13.6%), so that at the end of the study period, the discrepancy between whites and blacks had actually increased. 18 …”

Section: Discussionmentioning

confidence: 99%

“…Longer than whites More likely than whites More likely than whites Door-to-drug times 12 Prescribed aspirin 5 Survive and be discharged (when not treated with revascularization) 3 Door-to-balloon times 12 Rehospitalization (nonwhites) 11 More likely than whites Less likely than whites Recurrent AMI (nonwhites) 11 Slower transfer to revascularization hospital 14 Diagnostic cardiac catheterization 5 Recurrent AMI (5 years post-PCI) 32 Less likely than whites Catheterization 31,33 Rehospitalized for AMI (<1 year post-AMI) 18 Door-to-balloon times <90 minutes 13 Non-protocol mandated angiography (nonwhites) 11 Death (nonwhites) 11 Transfer to hospital with revascularization services 15 Use of lidocaine 6 Death following CABG (nonwhites) 28 PCI 5,7 Mortality (>30 days post-AMI) 15 PCI or CABG within 3 months of AMI 17 Mortality (5 years post-PCI) 32 Revascularization (admitted to nonrevascularization hospital) 15 Rehospitalization or death within 1 year post-CHD hospitalization 30 Revascularization 3,16,34 Adverse cardiac outcomes (1-year post revascularization) 35 6 Receive stent if undergoing PCI (nonwhites) 11 Less likely than whites Stress test 33 Procedural success with PCI (nonwhites) 11 Echocardiogram 33 Mortality <30 days post-AMI 15 Drug-eluting stents 4 Prescribed prasugrel 4 Prescribed clopidogrel 5 Prescribed GP IIb/IIIa inhibit...…”

Section: Delays Treatments Outcomesmentioning

confidence: 99%

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Graham

2016

Clinical Cardiology

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In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non‐Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non‐Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non‐Hispanic white ACS/MI patients were the 3 most‐studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.

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National Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010

Cited by 51 publications

References 40 publications

Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals

Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

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