Recent Trends in Post-Discharge Mortality Among Patients With an Initial Acute Myocardial Infarction

Abstract

The objectives of this study were to describe contemporary post-discharge death rates of patients hospitalized at all Worcester (MA) hospitals after an initial acute myocardial infarction (AMI) and to examine factors associated with a poor prognosis. We reviewed the medical records of patients discharged from 11 central Massachusetts medical centers after an initial AMI during 2001, 2003, 2005, and 2007, identifying 2,452 patients. This population was comprised of predominantly older individuals, men (58%), and whites. Overall, the 3 month, 1 year, and 2 year all-cause death rates were 8.9%, 16.4%, and 23.4%, respectively. Over time, reductions in post-discharge mortality were observed in crude as well as multivariable adjusted analyses. In 2001, the 3 month, 1 year, and 2 year all-cause death rates were 11.1%, 17.1%, and 25.6%, respectively, compared with rates of 7.9%, 12.7%, and 18.6% among patients discharged in 2007. Older age, male sex, hospitalization for an NSTEMI, renal dysfunction, and pre-existing heart failure were associated with an increased risk of dying after hospital discharge. Our results suggest that the post-discharge prognosis of patients with an initial AMI has improved, likely reflecting both enhanced inhospital and post-discharge management practices. In conclusion, patients with an initial AMI can also be identified who are at increased risk for dying after hospital discharge in whom increased surveillance and targeted treatment approaches can be directed.

Trends in mortality and recurrent coronary heart disease events after an acute myocardial infarction among Medicare beneficiaries, 2001-2009

“…Over that 20 year period, in-hospital, 30-day, and 1-year mortality after AMI declined dramatically, but this decline was more apparent in white men and women. 12 Our results extend these findings by reporting on 1-year 15 as well as in the Atherosclerosis Risk in Communities (ARIC) study. 8 These declines were likely the result of multiple factors.…”

Comparative evaluation of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring systems in patients admitted to the cardiac intensive care unit

“…The high prevalence of comorbidities in our cohort is consistent with the published literature and could have contributed to the observed mortality in our population, which was 38% for the total cohort at 6 months after hospital discharge. The prognostic importance of comorbidities for short-and long-term survival in cardiology patients and patients with coronary artery disease has previously been shown [34][35][36], suggesting that coexisting illnesses should be taken into account for quality comparisons in clinical trials.…”

Late Consequences of Acute Coronary Syndromes: Global Registry of Acute Coronary Events (GRACE) Follow-up

“…Although the early risks of death and (re)infarction have been well described, 1-10 the later treatment and consequences for this population remain less clearly defined. [11][12][13][14][15] Relatively few, large contemporary studies 7,8,15 have described the management and outcomes for the spectrum of acute coronary syndrome patients, including those with unstable angina. The GRACE follow-up cohort was comprised of more than 5000 patients with each final diagnosis subtype, with 64-84% of patients undergoing cardiac catheterization and more than 10,000 patients receiving coronary revascularization during the index hospitalization, and prescribed relatively high use of guideline-recommended secondary prevention therapies at discharge.…”

“…We 9,16,17 and others 1,5,6,10,11,15,22,[27][28][29] have identified risk factors associated with short term outcome following an acute coronary syndrome. However, convenient, bedside risk scores predicting longer term outcome in the broad spectrum of patients are limited.…”

“…[11][12][13][14][15] Risk scores are available to predict short term outcome 9,16,17 from the Global Registry of Acute Coronary Events (GRACE) an observational study of more than 70,000 acute coronary syndrome patients from 123 hospitals in 14 countries from 1999-2007. 18-20 Given the considerable variability that exists among patients across the entire spectrum of acute coronary syndromes (including myocardial infarction and unstable angina), estimation of risk, including beyond the shorter term, may assist in determining optimal longer term management.…”