Recent Trends in Hospitalization for Acute Myocardial Infarction

doi:10.1016/j.amjcard.2012.01.381

The American Journal of Cardiology

Volume 109, Issue 11, 1 June 2012, Pages 1589-1593

https://doi.org/10.1016/j.amjcard.2012.01.381 Get rights and content

Rates of acute myocardial infarction (AMI) hospitalizations for elderly Medicare patients decreased during the previous decade. However, trends in population rates of AMI hospitalizations for all adults by subgroups have not been described. Using data from a large all-payer administrative database of hospitalizations, we calculated annual AMI hospitalization rates from 2001 through 2007. Trend analysis was performed across age, gender, and ethnicity categories using survey regression. Overall rate decreased from 314 to 222 AMI hospitalizations per 100,000 patients from 2001 through 2007, representing a 29.2% decrease. Significant decreases were observed in AMI hospitalization rate for each group by age categories (p <0.001) and by gender (p <0.001). When stratified by ethnicity and gender, age-adjusted AMI hospitalization rates in white men and women decreased by 30.8% and 31.4%, whereas black men and women had significantly slower rates of decrease of 13.6% and 12.6%, respectively. In conclusion, although the overall rate of AMI hospitalizations decreased from 2001 through 2007, the observed decrease was smaller for black patients compared to white patients across all age groups studied.

Section snippets

Methods

The NIS from the HCUP is a longitudinal hospital inpatient database containing all discharge data from >1,000 hospitals in 41 states, approximating a 20% stratified sample of United States community hospitals. The NIS captures incident and recurrent AMI hospitalizations. Data include discharge-level data files with trend weights and data elements consistently defined across data years (http://www.hcup-us.ahrq.gov/db/nation/nis/nistrends.jsp). Using NIS data in the HCUP from 2001 through 2007,

Results

There were 2,179,509 AMI hospitalizations from 2001 through 2007 in the study sample. Overall rate decreased from 314 AMI hospitalizations per 100,000 patients to 222 AMI hospitalizations per 100,000 patients, representing a 29.2% decrease. The decrease in AMI hospitalizations occurred in the setting of a 5.2% decrease in the population-based rate of hospitalizations in the same dataset. There was a significant decrease (with relative decreases in percentages) over the study period in AMI

Discussion

The AMI hospitalization rate for adult patients from an all-payer database has decreased 29.2% from 2001 through 2007. Had overall hospitalization rates remained at 2001 levels over the study period, this would have resulted in approximately 500,000 more AMI hospitalizations from 2001 through 2007. This overall decrease in AMI hospitalizations was observed across almost all age, ethnicity, and gender categories studied. Excluding the youngest patients, in whom the incidence is comparatively

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Cited by (40)

ST-Elevation Myocardial Infarction Outcomes: A United States Nationwide Emergency Departments Cohort Study
2022, Journal of Emergency Medicine
Citation Excerpt :
Another study revealed that although 30-day case-fatality rates had remained stable, the 1-year mortality rates in patients with STEMI had decreased between 1997 and 2005 (25). Similarly, previous studies have reported improvement in mortality from STEMI over the last few decades (25,26). In our study, however, we observed that the yearly mortality trend remained relatively steady over the study years: 7.56% in 2011 to 7.50% in 2018 (linear p-trend 0.2364).
Literature regarding trends in incidence and mortality of ST-elevation myocardial infarction (STEMI) in emergency departments (EDs) is limited.
To study the trends of incidence and mortality of STEMI.
Using the National Emergency Department Sample database in the United States, we identified all ED encounters for patients presenting with STEMI using International Classification of Diseases codes. A linear p-trend was used to assess the trends.
Out of the 973 million ED encounters represented, 641,762 (65/100,000; mean age 69 [59–81] years, 35.8% female) adult patients were recorded with STEMI. Among the major complications associated with STEMI, a total of 49,401 (7.7%) had cardiac complications, which included acute heart failure (n = 9361, 1.6%), ventricular tachycardia or fibrillation (n = 12,267, 1.91%), conduction block (n = 20,165, 3.1%), and cardiogenic shock (n = 7608, 1.2%). There were 5675 (0.9%) patients recorded with cerebrovascular events, which included acute ischemic stroke among 5205 (0.8%) patients and 470 (0.1%) with transient ischemic attack. Acute kidney injury was recorded for 10,082 (1.6%) patients. The trend for incidence of STEMI in the ED had decreased from 7.76/10,000 in 2011 to 4.07/10,000 in 2018 (linear p-trend 0.0006). However, the yearly mortality of STEMI related to ED encounters had remained relatively steady: 7.56% in 2011 to 7.50% in 2018 (linear p-trend 0.2364).
Despite the fact that the number of patients presenting to the ED with STEMI has been decreasing, the mortality trends have remained steady. Further research of in-hospital STEMI may yield opportunities to reduce the risk of complications, improve patient outcomes and decrease health care burden.
Trends in hospitalizations for heart failure, acute myocardial infarction, and stroke in the United States from 2004 to 2018
2022, American Heart Journal
Citation Excerpt :
Overemphasis on readmission prevention and lack of efforts directed toward prevention of initial hospitalizations and addressing the changing demographics of HF population may have contributed to the uptrend in hospitalizations for HF. Consistent with previous analyses,4,20,21 our study shows a continuous decline in AMI hospitalizations. In an analysis between 2000 and 2014, there was a decline in age- and sex-standardized AMI hospitalizations.21
To determine the trends in hospitalizations for heart failure (HF), acute myocardial infarction (AMI), and stroke in the United States (US).
A retrospective analysis of the National Inpatient Sample weighted data between January 1, 2004 and December 31, 2018 which included hospitalized adults ≥18 years with a primary discharge diagnosis of HF, AMI, or stroke using International Classification of Diseases-9/10 administrative codes. Main outcomes were hospitalization for HF, AMI, and stroke per 1000 United States adults, length of stay, and in-hospital mortality. There were 33.4 million hospitalizations for HF, AMI, and stroke, with most being for HF (48%). After the initial decline in HF hospitalizations (5.3 hospitalizations/1000 US adults in 2004 to 4 hospitalizations/1000 US adults in 2013, P < .001), there was a progressive increase in HF hospitalizations between 2013 and 2018 (4.0 hospitalizations/1000 US adults in 2013 to 4.9 hospitalizations/1000 US adults in 2018; P < .001). Hospitalization for AMI decreased (3.1 hospitalizations/1000 US adults in 2004 to 2.5 hospitalizations/1000 US adults in 2010, P < .001) and remained stable between 2010 and 2018. There was no significant change for hospitalization for stroke between 2004 and 2011 (2.3 hospitalizations/1000 US adults in 2004 vs 2.3 hospitalizations per 1000 US adults in 2011, P = .614); however, there was a small but significant increase in hospitalization for stroke after 2011 that reached 2.5 hospitalizations/1000 US adults in 2018. Adjusted length of stay and in-hospital mortality decreased for HF, AMI, and stroke hospitalizations.
In contrast to the trend of AMI and stroke hospitalizations, a progressive increase in hospitalizations for HF has occurred since 2013. From 2004 to 2018, in-hospital mortality has decreased for HF, AMI, and stroke hospitalizations.
Acute myocardial infarction in the young with diabetes mellitus- national inpatient sample study with sex-based difference in outcomes
2021, International Journal of Cardiology
Citation Excerpt :
In the YOUNG-MI registry, only 12.5% of patients are on statins at the time of presentation for acute AMI [21], whereas for the VIRGO study population, only about 50% are aware of their high-risk cardiovascular risk status [22,23]. Previously, a large nationwide database analysis showed a more considerable decline in hospitalization in white men and women compared to black men and women aged 30–54 years [24]. In our study, we have a significantly higher number of black men than women which is in accordance with a previously published study using NIS, that showed young women were more likely to have diabetes as compared to men (35% vs. 23.7%; P < .001), though the proportion of black women was less than men (4.4% vs. 16%) [25].
Background: Mortality after AMI is on the decreasing trend; however, this favorable trend is not observed in the young, especially women. Therefore, we conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) to identify sex-based outcomes following AMI in young with diabetes.
Methods: NIS 2010–2014 was used to identify all patients with AMI using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Men (N = 30,950) and women (N = 17,928) patients diagnosed with diabetes were identified and stratified as young if age >18 and <45 years.
Results: Young women with AMI and concomitant diabetes having a higher burden of overall traditional and non-traditional comorbidities. NSTEMI was the major presentation in women as compared to men. Young women with AMI and concomitant diabetes were less likely to receive revascularization with PCI [51.1% vs. 58.2%; OR 0.86, CI 0.78–0.94] or CABG [7.9% vs. 10.1%; OR 0.64, CI 0.54–0.75]. Adjusted all-cause in-hospital mortality did not differ significantly between the two groups [OR 1.06, CI 0.74–1.52]. Women had lower odds of developing cardiogenic shock, ventricular arrhythmias, and AKI, and were more likely to develop major bleeding requiring transfusion, and mitral regurgitation.
Conclusion: There were significant differences between young men and women with diabetes in terms of baseline characteristics and clinical presentation, use of revascularization, and cardiac complications, yet overall, in-hospital mortality does not appear to differ. More studies are needed to identify the interaction of sex and diabetes in young AMI population, and areas for practice improvement.
Racial disparity in atherosclerotic cardiovascular disease in hospitalized patients with diabetes 2005–2015: Potential warning signs for future U.S. public health
2020, American Journal of Preventive Cardiology
The pattern of atherosclerotic cardiovascular disease (ASCVD) and diabetes driven hospitalizations in the United States (U.S.) is unclear. We attempted to identify the disparate outcome in race related ASCVD hospitalizations with comorbid diabetes.
Adults aged ≥40 years old with ASCVD (acute coronary syndrome (ACS), coronary artery disease (CAD), stroke, or peripheral arterial disease (PAD)) as the first-listed diagnosis with comorbid diabetes as a secondary diagnosis were determined using the U.S. 2005–2015 National (Nationwide) Inpatient Sample (NIS) data. The incidence of other modifiable cardiovascular risk factors (hypertension, dyslipidemia, smoking/substance abuse, obesity, and renal failure), in hospital procedures and outcomes was estimated. Complex samples multivariate regression was used to determine the odds ratio (OR) with 95% confidence Interval (CI) of risk associations and to determine patient comorbidity adjusted ASCVD related in-hospital mortality rate.
The rate of total ASCVD hospitalizations with comorbid diabetes adjusted to the U.S. census population increased by 5.7% for black men compared to 4% for black women. There was a higher odd of an ASCVD hospitalization if there was comorbid hypertension (Odds Ratio (OR 1.29; 95% CI 95% 1.28–1.31), dyslipidemia (OR 2.03; 95% CI 2.01–2.05), renal failure (OR 1.84; 95% CI 1.82–1.86), and smoking/substance use disorder (OR 1.31; 95% CI 1.29–1.33). White Women had the highest risk-adjusted incidence of ASCVD related in-hospital mortality (4.2%) relative to black women (3.9%), compared to white men (3.6%) and black men (3.5%) respectively.
Despite improving treatment options for ASCVD in the diabetic population, blacks with diabetes continue to have a higher hospitalization burden with a concomitant disparity in comorbid presentation and outcome. Further evaluation is the need to understand these associations.
Incidence of Ischaemic Heart Disease in Men and Women With End-Stage Kidney Disease: A Cohort Study
2020, Heart Lung and Circulation
The incidence of ischaemic heart disease (IHD) has fallen consistently in the general population; attributed to effective primary prevention strategies. Differences in incidence have been demonstrated by sex. Whether this fall in incidence and sex differences is mirrored in people with end-stage kidney disease (ESKD) is unclear. We aimed to establish the relative risk of IHD events in the ESKD population.
We performed a retrospective cohort study from 2000 to 2010 in people with ESKD in New South Wales. We performed data linkage of the Australia and New Zealand Dialysis and Transplant Registry and state wide hospital admission and death registry data and compared this to general population data. The primary outcome was the incidence rate, incidence rate ratio (IRR), and time-trend for any IHD event. We calculated these using indirect standardisation by IHD event.
10,766 participants, contributed 44,149 years of observation time. Incidence rates were substantially higher than the general population for all IHD events (any IHD event: IRR 1.8, 95% confidence interval [CI] 1.7–1.9 for men, IRR 3.4, 95% CI 3.1–3.6 for women). Excess risk was higher in younger people (age 30–49 IRR 4.8, 95% CI 4.2–5.4), and in women with a three-fold increase risk overall and nearly a 10-fold increase in risk in young women (female age 30–49 years: IRR 9.8 95% CI 7.7–12.3), results were similar for angina and acute myocardial infarction. Ischaemic heart disease rates showed some decline for men over time, (ratio of IRR 0.93, 95% CI 0.90–0.95) but were stable for women (ratio of IRR 0.97, 95% CI 0.94–1.01).
People with ESKD have substantially higher rates of IHD than the general population, especially women, in whom no improvement appears evident over the past 10 years.
Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN)
2017, American Journal of Medicine
Monitoring trends in cardiovascular events can provide key insights into the effectiveness of prevention efforts. Leveraging data from electronic health records provides a unique opportunity to examine contemporary, community-based trends in acute myocardial infarction hospitalizations.
We examined trends in hospitalized acute myocardial infarction incidence among adults aged ≥25 years in 13 US health plans in the Cardiovascular Research Network. The first hospitalization per member for acute myocardial infarction overall and for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction was identified by International Classification of Diseases, Ninth Revision, Clinical Modification primary discharge codes in each calendar year from 2000 through 2008. Age- and sex-adjusted incidence was calculated per 100,000 person-years using direct adjustment with 2000 US census data.
Between 2000 and 2008, we identified 125,435 acute myocardial infarction hospitalizations. Age- and sex-adjusted incidence rates (per 100,000 person-years) of acute myocardial infarction decreased an average 3.8%/y from 230.5 in 2000 to 168.6 in 2008. Incidence of ST-segment elevation myocardial infarction decreased 8.7%/y from 104.3 in 2000 to 51.7 in 2008, whereas incidence of non-ST-segment elevation myocardial infarction increased from 126.1 to 129.4 between 2000 and 2004 and then decreased thereafter to 116.8 in 2008. Age- and sex-specific incidence rates generally reflected similar patterns, with relatively larger decreases in ST-segment elevation myocardial infarction rates in women compared with men. As compared with 2000, the age-adjusted incidence of ST-segment elevation myocardial infarction in 2008 was 48% lower among men and 61% lower among women.
Among a large, diverse, multicenter community-based insured population, there were significant decreases in incidence of hospitalized acute myocardial infarction and the more serious ST-segment elevation myocardial infarctions between 2000 and 2008. Decreases in ST-segment elevation myocardial infarctions were most pronounced among women. While ecologic in nature, these secular decreases likely reflect, at least in part, results of improvement in primary prevention efforts.

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: This study was funded in part by the Robert Wood Johnson Clinical Scholars Program, New Haven, Connecticut and conducted in collaboration with the Yale University/National Heart, Lung, and Blood Institute Center for Cardiovascular Outcomes Research, New Haven, which is sponsored by Grant 1U01HL105270-01 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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Coronary artery diseaseRecent Trends in Hospitalization for Acute Myocardial Infarction

Section snippets

Methods

Results

Discussion

Am J Med

Am Heart J

Am Heart J

Am Heart J

2006 National Hospital Discharge Survey

Natl Health Stat Report

Recent declines in hospitalizations for acute myocardial infarction for Medicare fee-for-service beneficiaries: progress and continuing challenges

Circulation

Trends in incidence, severity, and outcome of hospitalized myocardial infarction

Circulation

Population trends in the incidence and outcomes of acute myocardial infarction

N Engl J Med

Coronary artery disease
Recent Trends in Hospitalization for Acute Myocardial Infarction