Decade-long Trends Research Articles

Decade-long trends (1999-2009) in the characteristics, management, and hospital outcomes of patients hospitalized with acute myocardial infarction with prior diabetes and chronic kidney disease.

BackgroundDespite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999–2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities.MethodsWe reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all eleven medical centers in central Massachusetts. Our sample consisted of the following four groups: DM with CKD (n=587), CKD without DM (n=524), DM without CKD (n=1,442), and non-DM/non-CKD (n=3,465).ResultsDiabetic patients with CKD were more likely to have a higher prevalence of previously diagnosed comorbidities, to have developed heart failure acutely, and to have a longer hospital stay compared with non-DM/non-CKD patients. Between 1999 and 2009, there were marked increases in the prescribing of beta-blockers, statins, and aspirin for patients with CKD and DM as compared to those without these comorbidities. In-hospital death rates remained unchanged in patients with DM and CKD, while they declined markedly in patients with CKD without DM (20.2% dying in 1999; 11.3% dying in 2009).ConclusionDespite increases in the prescribing of effective cardiac medications, AMI patients with DM and CKD continue to experience high in-hospital death rates.

Thirty-day Hospital Readmissions in Patients with Non-ST-segment Elevation Acute Myocardial Infarction

BackgroundLimited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non-ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI. MethodsWe reviewed the medical records of 2249 residents of the Worcester (Mass) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central Massachusetts medical centers. ResultsThe average age of our study population was 72 years, 90% were white, and 46% were women. The proportion of patients who were readmitted to the hospital for any cause within 30 days after discharge for an NSTEMI remained unchanged between 1999 and 2009 (approximately 15%) in both crude and multivariable adjusted analyses. Slight declines were observed for cardiovascular disease-related 30-day readmissions over the 10-year study period. Women, elderly patients, those with multiple chronic comorbidities or a prolonged index hospitalization, and patients who developed heart failure during their index hospitalization were at higher risk for being readmitted within 30 days than respective comparison groups. ConclusionThirty-day hospital readmission rates after hospital discharge for a first NSTEMI remained stable between 1999 and 2009. We identified several groups at higher risk for hospital readmission; further surveillance efforts and/or tailored educational and treatment approaches remain needed for these groups.

Decade-long Trends in Atrial Fibrillation Incidence and Survival: A Community Study

BackgroundContemporary data on temporal trends in incidence and survival after atrial fibrillation are scarce. MethodsResidents of Olmsted County, Minn., with a first-ever atrial fibrillation or atrial flutter event between 2000 and 2010 were identified. Age- and sex-adjusted incidence rates were standardized to the 2010 US population, and the relative risk of atrial fibrillation in 2010 versus 2000 was calculated using Poisson regression. Standardized mortality ratios of observed versus expected survival were calculated, and time trends in survival were examined using Cox regression. ResultsWe identified 3344 patients with incident atrial fibrillation/atrial flutter events (52% were male, mean age 72.6 years, 95.7% were white). Incidence did not change over time (age- and sex-adjusted rate ratio, 1.01; 95% confidence interval [CI], 0.91-1.13 for 2010 vs 2000). Within the first 90 days, the risk of all-cause mortality was greatly elevated compared with individuals of a similar age and sex distribution in the general population (standardized mortality ratios 19.4 [95% CI, 17.3-21.7] and 4.2 [95% CI, 3.5-5.0] for the first 30 days and 31 to 90 days after diagnosis, respectively). Survival within the first 90 days did not improve over the study period (adjusted hazard ratio, 0.96; 95% CI, 0.71-1.32 for 2010 vs 2000); likewise, no difference in mortality between 2010 and 2000 was observed among 90-day survivors (hazard ratio, 1.05; 95% CI, 0.85-1.31). ConclusionsIn the community, atrial fibrillation incidence and survival have remained constant over the last decade. A dramatic and persistent excess risk of death was observed in the 90 days after atrial fibrillation diagnosis, underscoring the importance of early risk stratification.

Characteristics, treatment practices, and in-hospital outcomes of older adults hospitalized with acute myocardial infarction.

To examine overall and decade-long trends (1999-2009), characteristics, treatment practices, and hospital outcomes in individuals aged 65 and older hospitalized for acute myocardial infarction (AMI) and to describe how these factors varied in the youngest, middle, and oldest-old individuals. Retrospective cohort study. Population-based Worcester Heart Attack Study. Analyses were conducted to examine the sociodemographic and clinical characteristics, cardiac treatments, and hospital outcomes of older adults in three age strata (65-74, 75-84, ≥85). The study sample consisted of 3,851 individuals aged 65 and older hospitalized with AMI every other year between 1999 and 2009; 32% were aged 65 to 74, 43% aged 75 to 84, and 25% aged 85 and older. Advancing age was inversely associated with receipt of evidence-based cardiac therapies. After multivariable adjustment, the odds of dying during hospitalization was 1.46 times as high in participants aged 75 to 84 and 1.78 times as high in those aged 85 and older as in those aged 65 to 74. The oldest-old participants had approximately 25% lower odds of a prolonged hospital stay (>3days) than those aged 65 to 74. Decade-long trends in the principal study outcomes were also examined. Although the oldest-old participants hospitalized for AMI were at the greatest risk of dying, persistent age-related differences were observed in hospital treatment practices. Similar results were observed after excluding participants with a do-not-resuscitate order in their medical records. Although there are persistent disparities in the care and outcomes of older adults hospitalized with AMI, additional studies are needed to delineate the extent to which less-aggressive care reflects individual preferences and appropriate implementation of palliative care approaches.

Decade-long trends in mortality among patients with and without diabetes mellitus at a major academic medical center.

The prevalence of diabetes has risen markedly over the past decade and is projected to increase substantially.1 Over 20 percent of hospitalized patients are estimated to have diabetes,2 and individuals with diabetes have historically suffered higher inpatient mortality than individuals without diabetes.3 Over the past decade, evidence from large clinical trials has prompted recommendations for tighter inpatient and outpatient glucose control as well as more stringent blood pressure and lipid management in order to improve outcomes for patients with diabetes.4–6 It is unclear whether the mortality impact of diabetes has changed as a consequence.

Climate change and observed climate trends in the fort cobb experimental watershed.

Recurring droughts in the Southern Great Plains of the United States are stressing the landscape, increasing uncertainty and risk in agricultural production, and impeding optimal agronomic management of crop, pasture, and grazing systems. The distinct possibility that the severity of recent droughts may be related to a greenhouse-gas induced climate change introduces new challenges for water resources managers because the intensification of droughts could represent a permanent feature of the future climate. Climate records of the Fort Cobb watershed in central Oklahoma were analyzed to determine if recent decade-long trends in precipitation and air temperature were consistent with climate change projections for central Oklahoma. The historical precipitation record did not reveal any compelling evidence that the recent 20-yr-long decline in precipitation was related to climate change. Also, precipitation projections by global circulation models (GCMs) displayed a flat pattern through the end of the 21st century. Neither observed nor projected precipitation displayed a multidecadal monotonic rising or declining trend consistent with an ongoing warming climate. The recent trend in observed annual precipitation was probably a decade-scale variation not directly related to the warming climate. On the other hand, the observed monotonic warming trend of 0.34°C decade that started around 1978 is consistent with GCM projections of increasing temperature for central Oklahoma.

Decade-long trends in the characteristics, management and hospital outcomes of diabetic patients with ST-segment elevation myocardial infarction

Our objectives were to describe recent trends in the characteristics and in-hospital outcomes in diabetic as compared with non-diabetic patients hospitalized with ST-segment elevation myocardial infarction (STEMI). We reviewed the medical records of 2537 persons with (n = 684) and without (n = 1853) a history of diabetes who were hospitalized for STEMI between 1997 and 2009 at 11 medical centres in Central Massachusetts. Diabetic patients were more likely to be older, female and to have a higher prevalence of previously diagnosed comorbidities. Diabetic patients were more likely to have developed important in-hospital complications and to have a longer hospital stay compared with non-diabetic patients. Between 1997 and 2009, there was a marked decline in hospital mortality in diabetic (20.0%-5.6%) and non-diabetic (18.6%-7.5%) patients. Despite reduced hospital mortality in patients hospitalized with STEMI, diabetic patients continue to experience significantly more adverse outcomes than non-diabetics.

Decade-Long Trends in the Magnitude, Treatment, and Outcomes of Patients Aged 30 to 54 Years Hospitalized With ST-Segment Elevation and Non–ST-Segment Elevation Myocardial Infarction

Although acute myocardial infarction (AMI) occurs primarily in the elderly, this disease also affects young adults. Few studies have, however, presented data on relatively young patients hospitalized with AMI. The objectives of this population-based study were to examine recent trends in the magnitude, clinical characteristics, management, and in-hospital and long-term outcomes associated with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients aged 30 to 54 years. We reviewed the medical records of 955 residents of the Worcester (Massachusetts) metropolitan area aged 30 to 54 years who were hospitalized for an initial STEMI or NSTEMI in 6 biennial periods from 1999 to 2009 at 11 greater Worcester medical centers. From 1999 to 2009, the proportion of young adults hospitalized with an STEMI decreased from approximately 2/3 to 2/5 of all patients with an initial AMI. Patients with STEMI were less likely to have a history of heart failure, hypertension, hyperlipidemia, and kidney disease than those with NSTEMI. Both groups received similar effective medical therapies during their acute hospitalization. In-hospital clinical complications and mortality were low and no significant differences in these end points were observed between patients with STEMI and NSTEMI or with regard to 1-year postdischarge death rates (1.9% vs 2.8%). The present results demonstrate recent decreases in the proportion of relatively young patients diagnosed with an initial STEMI. Patients with STEMI and NSTEMI had similar in-hospital outcomes and long-term survival. Trends in these and other important outcomes warrant continued monitoring.

Trends in the Medical Management of Patients With Heart Failure

BackgroundDespite the availability of effective therapies, heart failure (HF) remains a highly prevalent disease and the leading cause of hospitalizations in the U.S. Few data are available, however, describing changing trends in the use of various cardiac medications to treat patients with HF and factors associated with treatment. The objectives of this population-based study were to examine decade-long trends (1995 - 2004) in the use of several cardiac medications in patients hospitalized with acute decompensated heart failure (ADHF) and factors associated with evidence-based treatment.MethodsWe reviewed the medical records of 9,748 residents of the Worcester, MA, metropolitan area who were hospitalized with ADHF at all 11 central Massachusetts medical centers in 1995, 2000, 2002, and 2004.ResultsBetween 1995 and 2004, respectively, the prescription upon hospital discharge of beta-blockers (23%; 67%), angiotensin pathway inhibitors (47%; 55%), statins (5%; 43%), and aspirin (35%; 51%) increased markedly, while the use of digoxin (51%; 29%), nitrates (46%; 24%), and calcium channel blockers (33%; 22%) declined significantly; nearly all patients received diuretics. Patients in the earliest study year, those with a history of obstructive pulmonary disease or anemia, incident HF, non-specific symptoms, and women were less likely to receive beta blockers and angiotensin pathway inhibitors than respective comparison groups. In 2004, 82% of patients were discharged on at least one of these recommended agents; however, only 41% were discharged on medications from both recommended classes.ConclusionsOur data suggest that opportunities exist to further improve the use of HF therapeutics.

Community trends in the use and characteristics of persons with acute myocardial infarction who are transported by emergency medical services

ObjectiveLimited data exist on recent trends in ambulance use and factors associated with ambulance use in patients hospitalized with acute myocardial infarction (AMI), particularly from the more generalizable perspective of a community-wide investigation. This population-based prospective epidemiologic study describes the decade-long trends (1997-2007) in the use of emergency medical services (EMS) by residents of the Worcester, Massachusetts, metropolitan area who are hospitalized for AMI and the characteristics of patients with AMI who are transported to the hospital by EMS (n = 3789) compared with those transported by other means (n = 1505). MethodsThe study population consisted of 5294 patients hospitalized for AMI at 11 greater Worcester medical centers in 5 annual periods between 1997 and 2007. Information on the use of EMS and the factors associated with EMS use was obtained through the review of hospital medical records. ResultsThere was a progressive increase in the proportion of greater Worcester residents with AMI who were transported to central Massachusetts hospitals by ambulance over time (66.9% transported in 1997; 74.9% transported in 2007). Patients transported by EMS were older, more likely to be women, and more likely to have a greater prevalence of previously diagnosed comorbidities. ConclusionOur findings provide encouragement for the use of EMS in residents of a large central New England community hospitalized with AMI. Despite increasing trends in ambulance use, more research is needed to explore the reasons why patients with AMI do not use EMS in the setting of an acute cardiac emergency.

Thirty-Year (1975 to 2005) Trends in the Incidence Rates, Clinical Features, Treatment Practices, and Short-Term Outcomes of Patients

Sparse data are available describing recent trends in the magnitude, clinical features, treatment practices, and outcomes of comparatively young adults hospitalized with acute myocardial infarction (AMI). The objectives of this population-based study were to describe 3 decade-long trends (1975 to 2005) in these end points in adults <55 years old who were hospitalized with an initial AMI. The study population consisted of 1,703 residents of the Worcester (Massachusetts) metropolitan area 25 to 54 years of age who were hospitalized with initial AMIs at all central Massachusetts medical centers during 15 annual periods from 1975 through 2005. Overall hospital incidence rate (per 100,000 residents) of initial AMI in our study population was 66 (95% confidence interval 63 to 69) and incidence rates of AMI decreased inconsistently over time. Patients hospitalized during the most recent study years were more likely to have important cardiovascular risk factors and co-morbidities present but were less likely to have developed heart failure during their index hospitalization. In-hospital and 30-day death rates decreased by approximately 50% (p = 0.04) during the years under study concomitant with increasing use of effective cardiac therapies. In conclusion, the results of this community-wide investigation provide insights into the magnitude, changing characteristics, and short-term outcomes of comparatively young patients hospitalized with a first AMI. Decreasing odds of developing or dying from an initial AMI during the 30 years under study likely reflect increased primary and secondary prevention and treatment efforts.

Declining Length of Stay for Patients Hospitalized with AMI: Impact on Mortality and Readmissions

Background Length of hospital stay after acute myocardial infarction decreased significantly in the 1980s and 1990s. Whether length of stay has continued to decrease during the 2000s, and the impact of decreasing length of stay on rehospitalization and mortality, is unclear. We describe decade-long (1995-2005) trends in length of stay after acute myocardial infarction, and examine whether declining length of stay has impacted early rehospitalization and postdischarge mortality in a population-based sample of hospitalized patients. Methods The study sample consisted of 4184 patients hospitalized with acute myocardial infarction in a central New England metropolitan area during 6 annual periods (1995, 1997, 1999, 2001, 2003, 2005). Results The average age of the study sample was 71 years, and 54% were men. The average length of stay decreased by nearly one third over the 10-year study period, from 7.2 days in 1995 to 5.0 days in 2005 ( P <.001). Younger patients (<65 years), men, and patients with an uncomplicated hospital stay had significantly shorter lengths of stay than respective comparison groups. Lengths of stay shorter than the median were not associated with significantly higher odds of hospital readmission at 7 or 30 days postdischarge, or with mortality in the year after discharge. In contrast, longer lengths of stay were associated with significantly higher odds of short-term mortality. These findings did not vary by year under study. Conclusions Length of stay in patients hospitalized for acute myocardial infarction decreased significantly between 1995 and 2005. Declining length of stay is not associated with an increased risk for early readmission or all-cause mortality.

Dendrochemical Record of Historical Lead Contamination Sources, Wells G&amp;H Superfund Site, Woburn, Massachusetts

Laser-ablation inductively coupled-plasma mass-spectrometry analysis of red oak (Quercus rubra) from a well documented heavy metal contaminated United States Environmental Protection Agency superfund site in Woburn, Massachusetts reveals decade-long trends in Pb contaminant sources. Lead isotope ratios (207Pb/206Pb and 208Pb/206Pb) in tree rings plot along a linear trend bracketed by several local and regional contamination sources. Statistically significant interannual variations in 207Pb/206Pb suggest that atmospheric Pb is rapidly incorporated into wood, with minimal mobility subsequent to deposition in annual growth rings. We interpret the decadal trends in our record as a changing mixture of local pollution sources and gasoline-derived Pb. Between 1940 and 1970, Pb was predominantly derived from remobilization of local industrial Pb sources. An abrupt shift in 207Pb/206Pb may indicate that local Pb sources were overwhelmed by gasoline-derived Pb during the peak of leaded gasoline emissions in the late 1960s and early 1970s.

Decade-long changes in the use of combination evidence–based medical therapy at discharge for patients surviving acute myocardial infarction

Current practice guidelines suggest routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI). The objectives of our population-based study were to describe decade-long trends (1990-2001) in the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, lipid-lowering agents, and combinations thereof, in patients discharged from all metropolitan Worcester (Mass) hospitals after AMI. The study sample consisted of 5965 adult men and women of all ages discharged after AMI from all greater Worcester hospitals in 7 annual periods between 1990 and 2001. Although consistent increases in the use of each of the effective cardiac medications examined were observed over time, particularly marked relative increases in the use of angiotensin-converting enzyme inhibitors (168% relative increase) and lipid-lowering agents (1086% relative increase) were noted. Use of combinations of effective cardiac medications also increased substantially over time. Between 1990 and 2001, the percentage of hospital survivors treated with > or =3 cardiac medications increased from 12.9% to 74.0%. Advancing age, female sex, history of angina, hypertension, or heart failure during hospitalization, presence of an initial non-Q wave MI, and development of atrial fibrillation during the index hospitalization were independently associated with underuse of combination medical therapy. The present results suggest considerable improvements over the last decade in the medical management of patients hospitalized with AMI. Educational efforts, however, aimed at clinicians and designed to improve use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.

Trends in Precipitation, Streamflow, and Evapotranspiration in the Great Plains of the United States

Planning and strategic management of water resources are contingent on trends in water availability. In this study, the impact of decade-scale variations in annual and seasonal precipitation on streamflow and evapotranspiration (ET) were identified for 10 watersheds in Nebraska, Kansas, and Oklahoma. In the Great Plains, an upward trend in precipitation over the last two decades of the 20th Century had a strong impact on streamflow and a comparatively weaker impact on ET. Even though precipitation, streamflow, and ET amounts differed between watersheds, the trend due to the precipitation increase was similar for all watersheds. Increased precipitation led to a disproportionately large increase in streamflow and comparatively smaller increase in ET. On average, a 12% increase in annual precipitation led to a 64% increase in streamflow, but only a 5% increase in ET. The seasonal partitioning of the annual precipitation increase was, in most cases, biased toward the fall, winter, and spring, with little or no change during the hot summer months. The strong streamflow response indicated that planning and management of surface-water storage and supply can be critically impacted by decade-long trends in precipitation. The lack of significant increase in precipitation and streamflow during summer suggests that any existing shortages will likely remain despite the observed annual precipitation increase. The ET response suggests that dryland farming and ecosystem vitality could benefit from the increased precipitation in fall, winter, and spring, but the relative impacts are more modest compared to the streamflow response and do not occur during summer when potential ET is greatest. Finally, since the mid-1990s precipitation and streamflow in a number of Oklahoma watersheds have shown a gradual decline from peak values in the late 1980s toward more average conditions. This declining trend in streamflow may be important for planning and management of water resources systems that must meet an increasing demand for water by a growing society while at the same time considering environmental and recreational needs.

Lung Cancer Incidence in the Province of Avila, Spain, in 2002 and Decade-Long Trends

To determine lung cancer incidence in the province of Avila, Spain, in the year 2002 and compare it with incidences reported in 2 previous studies (for 1992-1993 and 1997). Patients diagnosed in 2002 were evaluated prospectively by the method used in the previous studies. The reference population was obtained from the municipal records for 2001. In 2002, 87 patients (74 men and 13 women) were diagnosed with lung cancer. The crude incidence rate was 53.09 cases per 100 000 population (men: 89.92/100 000; women: 15.93/100 000). Of these, 87.3% had been smokers. Squamous cell carcinomas were the most frequent type overall (38.1%) and in men (42.4%). Adenocarcinomas were the most frequent type in women (60%). The most frequent treatment was chemotherapy (35.6%). Between the 1992-1993 study and our 2002 study, significant increases were found in crude incidence rates of lung cancer and the use of chemotherapy, as well as significant decreases both in squamous cell carcinomas and the use of radiotherapy alone. Between 1992 and 2002 the lung cancer incidence in men and women in the province of Avila increased significantly.

Changes over time in the use of aspirin in patients hospitalized with acute myocardial infarction (1975 to 1997): A population-based perspective

Objective The purpose of this study was to examine 2 decade-long trends in the use of aspirin and associated outcomes in patients hospitalized with acute myocardial infarction. Background Aspirin has been shown to be beneficial in the secondary prevention of AMI. However, little is known about changes over time in the use of aspirin in patients hospitalized with AMI and associated outcomes, particularly from a more generalizable population-based perspective. Methods We examined trends in aspirin use and hospital and long-term outcomes in 9336 metropolitan Worcester, Mass, residents hospitalized with validated AMI in all area hospitals between 1975 and 1997. Results Between 1975 and 1986, the hospital use of aspirin remained stable at approximately 20%. Use of aspirin increased markedly after this time from 49% in 1988 to 91% in 1997. Younger age, male sex, and a history of hypertension or stroke were associated with an increased likelihood of receiving aspirin. Patients with diabetes were less likely to receive aspirin than were patients without diabetes. Patients who received aspirin during hospitalization were more likely to receive β-blockers and coronary interventions. Patients treated with aspirin were significantly less likely to have heart failure or cardiogenic shock develop or to die during hospitalization as compared with patients not treated with aspirin. Patients treated with aspirin had significantly higher survival rates over a 10-year follow-up period. Conclusion The results of this community-wide study show that aspirin use in patients hospitalized with AMI has dramatically increased over time. Despite the beneficial effects associated with the use of aspirin, this therapy remains underused in several high-risk groups. (Am Heart J 2002;144:259-68.)

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Decade-long trends (1986 to 1997) in the medical treatment of patients with acute myocardial infarction: A community-wide perspective

Background Although there are an increasing number and variety of medications available for the treatment of patients with acute myocardial infarction (AMI), few data are available describing recent, and changes over time in, use of different cardiac medications in patients with AMI from a more generalizable, community-wide perspective. Moreover, it is unclear whether the demographic and clinical profile of patients receiving these agents is similar or varies according to the type of agent prescribed. Methods and Results The purpose of this study was to examine recent patterns and changes over a decade-long period (1986 to 1997) in the use of cardiac medications during the acute hospitalization and at the time of hospital discharge in metropolitan Worcester, Mass, residents (1990 census estimate, 437,000) hospitalized with confirmed AMI. There was a marked increase in the use of angiotensin-converting enzyme inhibitors, aspirin, β-blockers, lipid-lowering agents, and thrombolytic therapy between 1986 and 1997. The use of calcium antagonists, lidocaine, and other antiarrhythmic agents declined over this period. Similar trends were observed in the use of these agents in hospital survivors at the time of hospital discharge. Patient age, presence of comorbidities, and AMI-associated characteristics influenced the use of these therapies; sex differences in the use of several of these medications were also noted. Conclusions The results of this population-based observational study provide insights into changing prescribing patterns in the hospital treatment of patients with AMI. Despite encouraging increases in the use of several of these agents, considerable opportunities for increased utilization remain. (Am Heart J 2001;142:594-603.)

Temporal trends (1986-1997) in cholesterol level assessment and management practices in patients with acute myocardial infarction: a population-based perspective.

Elevated serum cholesterol levels are associated with increased risk for acute myocardial infarction (AMI) and adverse patient outcomes. It is unclear what proportion of patients have their serum cholesterol levels measured during hospitalization for AMI and are given hypolipidemic therapy. To examine decade-long trends in measurement of serum cholesterol levels during hospitalization for AMI and use of hypolipidemic therapy. Observational study of 5204 residents of the Worcester, Mass, metropolitan area hospitalized with validated AMI in all greater Worcester hospitals in seven 1-year periods from 1986 through 1997. Increases in the measurement of serum cholesterol levels during hospitalization for AMI were observed between 1986 and 1991, followed by a progressive decrease; only 24% of patients with AMI in 1997 underwent cholesterol level testing. Younger age, male sex, and absence of a history of cardiovascular disease were associated with an increased likelihood measurement of serum cholesterol levels. Although the relative use of hypolipidemic therapy increased significantly over time (0.4% in 1986 vs 10.7% in 1997), the absolute rate of use remained low. In patients with elevated serum cholesterol levels (>/=6.2 mmol/L [>/=240 mg/dL]), 1.9% received hypolipidemic therapy in 1986 and 36.6% in 1997. These findings suggest recent declines in the assessment of total cholesterol levels in patients hospitalized with AMI. Although the use of hypolipidemic therapy during hospitalization for AMI has increased over time, considerable room for improvement remains.