Abstract P367: Trends in Mortality and Recurrent Coronary Heart Disease Events Following an Acute Myocardial Infarction Among Medicare Beneficiaries, 2001 - 2009

Abstract

Background: Few contemporary studies examine trends in recurrent coronary heart disease (CHD) events and mortality following acute myocardial infarction (AMI). Therefore, we examined rates of mortality, recurrent AMI, and recurrent CHD events in the year following AMI overall and by race and sex in the national 5% random sample of Medicare beneficiaries. Methods: Beneficiaries were included if they were enrolled in traditional Medicare fee-for-service coverage (Parts A and B), were not enrolled in a Medicare Advantage plan, and experienced an index AMI (ICD9 410.xx except 410.x2) between January 1, 2001 and December 31, 2009. We used Poisson regression to calculate and examine linear changes in age-adjusted rates for all-cause mortality, recurrent AMI, and recurrent CHD events (defined as a hospitalization for AMI in the primary discharge diagnosis position, percutaneous coronary intervention, or coronary artery bypass graft surgery) during the 365 days following hospital discharge for the index AMI. To provide adequate sample size to investigate trends in outcomes by race-sex groups, we pooled calendar years into 3 time periods (2001-2003, 2004-2006, and 2007-2009). Results: Overall, 48,688 beneficiaries were included; 46% were men, 90% were white, and 7% were black. Changes in pooled 3 year rates for mortality, recurrent AMI, and recurrent CHD in the first year following an index AMI are shown in the table. Overall, we observed a -3.8% change in pooled 3 year age-adjusted rates for mortality, a -15.0% change in pooled 3 year age-adjusted rates for recurrent AMI, and a -11.1% change in pooled 3 year age-adjusted rates for recurrent CHD events. However, mortality following AMI decreased only in white men, and reductions in recurrent AMI or CHD occurred only for white men and women and black men but not black women. Conclusions: Despite the overall favorable trends in lower mortality and recurrent AMI and CHD events following an index AMI, more efforts in reducing disparities in CHD by race and sex are needed.