Hospital Discharge For Myocardial Infarction Research Articles

Abstract 14678: Racial/Ethnic Disparities in Low-Density Lipoprotein Cholesterol Testing Following Myocardial Infarction Hospitalization Among Medicare Beneficiaries in the United States, by State

Introduction: Low-density lipoprotein cholesterol (LDL-C) is used to guide lipid-lowering treatment following hospitalization for myocardial infarction (MI). Recent analyses illustrate a lack of short-term LDL-C testing across the United States, but it is unclear whether race/ethnicity differences exist in all states. Lack of LDL-C testing following an MI may represent a missed opportunity to identify groups of patients with low response to lipid-lowering therapy. Research Question: Does use of LDL-C testing at 90 days post-MI differ by race in each state and across states? Methods: We conducted a retrospective cohort study of Medicare beneficiaries with fee-for-service coverage, pharmacy benefits, and ≥66 years of age with an MI hospitalization between 2016 and 2020 and estimated the cumulative incidence of LDL-C testing at 90 days post-MI overall, by state, and by race. Results: Of the 532,767 MI hospitalizations, 84.4% and 8.4% were among non-Hispanic White and non-Hispanic Black beneficiaries, respectively, with Asian and Hispanic beneficiaries each representing 2.0% of the hospitalizations. The cumulative incidence of LDL-C testing in the US was 29.9%. Hawaii had the highest overall cumulative incidence of LDL-C testing (43%) while Arkansas had the lowest (17%). Cumulative incidence of LDL-C testing was lowest among non-Hispanic Blacks (26.0%) compared to all other racial groups with testing rates between 30-33%. In most states, cumulative incidence of LDL-C testing among Non-Hispanic Blacks was lower than the state average, whereas among Whites it was higher than the state average (see Table 1). Conclusions: LDL-C testing was low in the 90 days after hospital discharge for MI among Medicare beneficiaries, with substantial geographic and race disparities. In many states, our data suggests testing for Black Americans was lower than the state average. Funding: Amgen Inc.

Recurrent atherosclerotic cardiovascular disease events preventable with guideline recommended lipid-lowering treatment following myocardial infarction

Abstract Background The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline provides recommendations for lipid-lowering therapy (LLT) including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to prevent recurrent atherosclerotic cardiovascular disease (ASCVD) events in adults with established ASCVD. Many adults with ASCVD who are recommended to take statins, ezetimibe and/or PCSK9i do not receive these medications. Purpose To estimate the number of recurrent ASCVD events potentially prevented by population-wide use of guideline recommended LLT following a myocardial infarction (MI). Methods We simulated the population-wide impact of receipt of 2018 AHA/ACC cholesterol guideline recommended LLT over 3 and 5 years among US adults with government health insurance through Medicare or commercial health insurance following hospital discharge for MI. We used data from patients with an MI hospitalization in 2018–2019 to estimate the percentage receiving guideline recommended LLT defined by having the medications available to take in the 30 days after their discharge date. We used data from patients with an MI hospitalization in 2013–2016 to estimate the 3 and 5-year cumulative incidence of recurrent ASCVD events (i.e., MI, coronary revascularization or ischemic stroke). The reduction in ASCVD events associated with guideline recommended LLT was estimated from a meta-analysis by the Cholesterol-Lowering Treatment Trialists Collaboration. We conducted a sensitivity analysis estimating the number and percentage of ASCVD events prevented if LLT recommendations from the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) cholesterol guideline were followed. We repeated all analyses with recurrent coronary heart disease (i.e., MI or coronary revascularization) and ischemic stroke events as separate outcomes. Results Among 279,395 adults with an MI hospitalization in 2018–2019 (mean age 75 years, 54% men, mean low-density lipoprotein cholesterol 92 mg/dL), 27% were receiving guideline recommended LLT. With current lipid-lowering medication use, we estimated that 70,698 (95% CI: 70,311–71,077) and 89,255 (95% CI: 88,841–89,730) ASCVD events would occur in 3 and 5 years, respectively, after MI hospital discharge (Table, top panel). If all patients were to receive 2018 AHA/ACC guideline recommended LLT, the number of ASCVD events was estimated to be reduced by 21.6%, representing 15,264 (95% CI: 14,451–16,679) events prevented over 3 years and 19,271 (95% CI: 18,245–21,055) events prevented over 5 years. A higher number of recurrent ASCVD events were estimated to be averted following the LLT recommendations of the 2019 ESC/EAS cholesterol guideline (Table, bottom panel). Conclusions Population-wide implementation of guideline recommended LLT in adults with an MI hospitalization could prevent a substantial number of recurrent ASCVD events. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Amgen Inc.

Effects of an intensive long-term prevention programme after myocardial infarction – a randomized trial

Long-term risk factor control after myocardial infarction (MI) is currently inadequate and there is an unmet need for effective secondary prevention programmes. It was the aim of the study to compare a 12-month intensive prevention programme (IPP), coordinated by prevention assistants and including education sessions, telephone visits and telemetric risk factor control, with usual care after MI. Three hundred and ten patients were randomized to IPP vs. usual care one month after hospital discharge for MI in two German heart centres. Primary study endpoint was the IPP Prevention Score (0-15 points) quantifying global risk factor control. Global risk factor control was strongly improved directly after MI before the beginning of the randomized study (30% increase IPP Prevention Score). During the 12-month course of the randomized trial the IPP Prevention Score was improved by a further 14.3% in the IPP group ( p < 0.001), while it decreased by 11.8% in the usual care group ( p < 0.001). IPP significantly reduced smoking, low-density lipoprotein cholesterol, systolic blood pressure and physical inactivity compared with usual care ( p < 0.05). Step counters with online documentation were used by the majority of patients (80%). Quality of life was significantly improved by IPP ( p < 0.05). The composite endpoint of adverse clinical events was slightly lower in the IPP group during 12 months (13.8% vs. 18.9%, p = 0.25). A novel intensive prevention programme after MI, coordinated by prevention assistants and using personal teachings and telemetric strategies for 12 months, was significantly superior to usual care in providing sustainable risk factor control and better quality of life.

Prospective utility study of patients with multiple cardiovascular events

Objectives: The effects of acute coronary syndrome (ACS) events on health-related quality-of-life (HRQoL) and the time dependency of these effects are unknown. This study aimed to characterize health utilities in ACS patients to aid development of future economic models estimating the cost per quality-adjusted life-year impact of ACS events and potential treatments.Methods: Multi-center, non-interventional, longitudinal evaluation of health utility in patients experiencing ACS or stroke events. EuroQol-5 dimension 3 level (EQ-5D-3L) surveys were sent to patients (≥18 years) from three UK centers, 1 month after hospital discharge for myocardial infarction (MI), unstable angina (UA), or stroke. Patient demographics, lifestyle, and baseline utility score were collected in the first survey. Follow-up surveys were sent at 6, 12, 18, and 24 months to prospectively capture utility and subsequent health events. Two methods of patient identification were adopted—prospective, where the patient’s qualifying events occurred after the study index date, and retrospective, where the patient’s qualifying event occurred prior to the study index date. General healthy population utility values were assumed for pre-event HRQoL.Results: Between January 2011 and March 2014, 2,103 prospectively (n = 1,350)/retrospectively (n = 753) identified patients (mean age = 68.3 years; 67.9% male) responded: MI = 55.9% (n = 1,176), UA = 42.7% (n = 898), stroke = 1.4% (n = 29); 24% had type 2 diabetes. Post-event utility values were lower than general healthy population values, although significant differences in utility between subsequent 6 (n = 1,031, change = –0.002), 12 (n = 1,096, change = –0.008), 18 (n = 1,246, change = –0.007), and 24 (n = 1,277, change = –0.004) month timepoints were not detected. Through multivariate regression analyses, wheelchair use, current smoking, and secondary mental and joint health events were associated with the greatest statistically significant utility decrements.Conclusions: This study indicates that health utility decreases following a cardiovascular event and, although some improvement occurs over the subsequent 24 months, general healthy population utility is not necessarily attained.

Sex Differences in High-Intensity Statin Use Following Myocardial Infarction in the United States

BackgroundHistorically, women have been less likely than men to receive guideline-recommended statin therapy for the secondary prevention of myocardial infarction (MI). ObjectivesThe authors examined contemporary sex differences in prescription fills for high-intensity statin therapy following an MI, overall and across population subgroups, and assessed whether sex differences were attenuated following recent efforts to reduce sex disparities in the use of cardiovascular disease preventive therapies. MethodsThe authors studied 16,898 (26% women) U.S. adults <65 years of age with commercial health insurance in the MarketScan database, and 71,358 (49% women) U.S. adults ≥66 years of age with government health insurance through Medicare who filled statin prescriptions within 30 days after hospital discharge for MI in 2014 to 2015. The authors calculated adjusted women-to-men risk ratios and 95% confidence intervals (CIs) for filling a high-intensity statin prescription (i.e., atorvastatin 40 to 80 mg, and rosuvastatin 20 to 40 mg) following hospital discharge for MI. ResultsIn 2014 to 2015, 56% of men and 47% of women filled a high-intensity statin following hospital discharge for MI. Adjusted risk ratios for filling a high-intensity statin comparing women with men were 0.91 (95% CI: 0.90 to 0.92) in the total population, 0.91 (95% CI: 0.89 to 0.92) among those with no prior statin use, and 0.87 (95% CI: 0.85 to 0.90) and 0.98 (95% CI: 0.97 to 1.00) for those taking low/moderate-intensity and high-intensity statins prior to their MI, respectively. Women were less likely than men to fill high-intensity statins within all subgroups analyzed, and the disparity was largest in the youngest and oldest adults and for those without prevalent comorbid conditions. ConclusionsDespite recent efforts to reduce sex differences in guideline-recommended therapy, women continue to be less likely than men to fill a prescription for high-intensity statins following hospitalization for MI.

Abstract P155: Risk for Recurrent Events Among Patients Receiving Intensive Medical Management Following Myocardial Infarction

Background: Randomized trials have shown that several medications reduce the risk for recurrent coronary heart disease (CHD) events following myocardial infarction (MI). Knowing the risk for recurrent events among patients receiving intensive medical management following MI can inform patient-physician shared decision making. Objective: To estimate the risk for CHD events among patients receiving intensive medical management following an MI hospitalization. Methods: We identified US adults 18-64 years with commercial health insurance in Marketscan who had an MI hospitalization (defined by an ICD-9 code of 410.x0 or 410.x1 in the primary discharge diagnosis position) in 2014-2015. Intensive medical management was defined as filling a high-intensity statin, renin-angiotensin system inhibitor, beta-blocker and antiplatelet agent within 30 days following hospital discharge for MI. Patients receiving intensive medical management were matched 1:2 by age, sex and calendar year to randomly selected controls from the general population and followed for recurrent MI and CHD events (i.e., MI or coronary revascularization). Results: Among MI patients (n=17,643, mean age 55 years, 74% male), 29.6% received intensive medical management. After adjustment for comorbid conditions, intensive medical management was more common among men (relative risk [95% CI] 1.14 [1.07, 1.20]), those who received a stent during their MI hospitalization (2.54 [2.37, 2.73]) and those who received cardiologist care (1.17 [1.11, 1.22]) and cardiac rehabilitation (1.14 [1.08, 1.20]) after hospital discharge. The risk for recurrent MI and CHD events was higher among MI patients receiving intensive medical management compared to controls, overall and when restricted to MI patients with high medication adherence ( Table ). Conclusion: MI patients receiving intensive medical management have a substantial residual risk for recurrent CHD events.

Trends in Use of High-Intensity Statin Therapy After Myocardial Infarction, 2011 to 2014

BackgroundData prior to 2011 suggest that a low percentage of patients hospitalized for acute coronary syndromes filled high-intensity statin prescriptions upon discharge. Black-box warnings, generic availability of atorvastatin, and updated guidelines may have resulted in a change in high-intensity statin use. ObjectivesThe aim of this study was to examine trends and predictors of high-intensity statin use following hospital discharge for myocardial infarction (MI) between 2011 and 2014. MethodsSecular trends in high-intensity statin use following hospital discharge for MI were analyzed among patients 19 to 64 years of age with commercial health insurance in the MarketScan database (n = 42,893) and 66 to 75 years of age with U.S. government health insurance through Medicare (n = 75,096). Patients filling statin prescriptions within 30 days of discharge were included. High-intensity statins included atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg. ResultsThe percentage of beneficiaries whose first statin prescriptions filled following hospital discharge for MI were for high-intensity doses increased from 33.5% in January through March 2011 to 71.7% in October through November 2014 in MarketScan and from 24.8% to 57.5% in Medicare. Increases in high-intensity statin use following hospital discharge occurred over this period among patients initiating treatment (30.6% to 72.0% in MarketScan and 21.1% to 58.8% in Medicare) and those taking low- or moderate-intensity statins prior to hospitalization (from 27.8% to 62.3% in MarketScan and from 12.6% to 45.1% in Medicare). In 2014, factors associated with filling high-intensity statin prescriptions included male sex, filling beta-blocker and antiplatelet agent prescriptions, and attending cardiac rehabilitation within 30 days following discharge. ConclusionsThe use of high-intensity statins following hospitalization for MI increased progressively from 2011 through 2014.

Abstract P157: Sex Disparities in High Intensity Statin Use Following Myocardial Infarction

Background: High intensity statins have been shown to lower the risk of major cardiovascular events after an index myocardial infarction (MI). Studies have shown that women are less likely than men to receive cardiovascular risk reduction therapies but little is known about sex differences in high intensity statin use following hospital discharge for MI. Methods: We compared high intensity statin use following hospital discharge for MI in 2014 between men and women 19 to 64 years with commercial health insurance in the Marketscan database (n=7,089 men and 2,318 women) and Medicare beneficiaries ≥66 years (n=20,202 men and n=18,937 women). Patients were included if they filled a statin of any intensity within 30 days following hospital discharge. Statin fills were identified through pharmacy claims and high intensity statins included atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg. Results: Among patients not taking statins prior to having an MI (n=6,303 in Marketscan and n=17,763 in Medicare), 69.4% of men and 62.4% of women (p-value &lt;0.001) in the Marketscan database and 55.2% of men and 48.1% of women (p-value &lt;0.001) with health insurance through Medicare initiated treatment with a high intensity statin. Among patients taking low or moderate intensity statins prior to having an MI (n=2,234 in Marketscan and n=16,818 in Medicare), 58.0% of men and 49.2% of women (p-value &lt;0.001) in the Marketscan database and 38.2% of men and 31.7% of women (p-value &lt;0.001) in Medicare titrated to a high intensity statin within 30 days of hospital discharge. After multivariable adjustment, women were less likely to initiate treatment with a high intensity statin (relative risk: 0.92; 95% CI 0.88-0.96 in Marketscan and 0.92; 95% CI 0.90-0.95 in Medicare) or titrate from low/moderate to high intensity statin (relative risk: 0.89 95% CI 0.81-0.95 in Marketscan and 0.89; 95% CI 0.86-0.93 in Medicare). Among those taking a high intensity statin prior to their MI (n=870 in Marketscan and n=4,558 in Medicare), 92.0% and 87.4% of men and women, respectively, in Marketscan (adjusted relative risk 0.95; 95% CI 0.90-1.01) and 91.5% and 88.1% of men and women, respectively, in Medicare (adjusted relative risk 0.97; 95% CI 0.95-0.99), remained on a high intensity statin following hospital discharge. Conclusions: Women are less likely than men to receive high intensity statins following hospital discharge for MI.

Abstract 007: Titration From Low/moderate to High Intensity Statins Following Myocardial Infarction Among Patients With Diabetes

Background: High intensity statins have been shown to lower the risk of major cardiovascular events after a myocardial infarction (MI). Recent studies report that most people with diabetes who experience a coronary heart disease event are already taking a statin, but little is known about the percentage who are titrated to a high intensity statin following hospital discharge for a MI. Methods: We compared the percentage of patients with versus without diabetes who titrated from a low/moderate to a high intensity statin within 30 days following hospital discharge for MI in 2014. The analyses included 3,629 patients with diabetes and 3,502 patients without diabetes. All patients were 66 to 74 years of age, had government insurance through Medicare, and filled a low/moderate intensity statin without any high intensity statin fills within 365 days prior to having a MI. Also, all patients filled a statin within 30 days following hospital discharge. Statin fills were identified through pharmacy claims; high intensity statins included atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg. Results: Titration from low/moderate to high intensity statins following hospital discharge for MI occurred among 37.7% and 43.7% of beneficiaries with and without diabetes, respectively. After adjustment for demographics, low socioeconomic status and comorbidities, having diabetes was not associated with titrating to a high intensity statin following hospital discharge (risk ratio [RR]: 1.03; 95% CI 0.96-1.10). Among those with diabetes, African Americans compared with whites (RR 1.16; 95% CI 1.02-1.32) and men compared with women (RR 1.14; 95% CI 1.05-1.25) were more likely to titrate from a low/moderate statin to a high intensity statin. Also, titration to a high intensity statin was less common among those with a history of heart failure (RR 0.79; 95% CI 0.69-0.90), those who had seen a cardiologist in the year prior to their MI (RR 0.90; 0.81-1.00), and those who had filled a non-statin lipid-lowering medication within 30 days following hospital discharge (RR 0.50; 95% CI 0.38-0.64). Titration to a high intensity statin was more common among those with diabetes filling a beta blocker (RR 1.15; 95% CI 1.02-1.28) or antiplatelet agent (RR 1.13; 95% CI 1.04-1.24) and attending cardiac rehabilitation (RR 1.22; 95% CI 1.09-1.36) within 30 days following hospital discharge. Only 9.0% of patients with diabetes whose first statin fill following hospital discharge was for a low/moderate-intensity dose filled a high intensity statin within the next 6 months. Conclusions: Most patients with diabetes do not titrate to a high intensity statin following hospital discharge for MI, potentially leaving substantial residual risk for recurrent MI. Further research into the under treatment of patients with diabetes is needed.

Abstract 188: Hospital and Regional Variation in Use of High-intensity Statins Following Myocardial Infarction Among Medicare Beneficiaries

Background: American College of Cardiology/American Heart Association guidelines published in 2013 recommend high-intensity statins (atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg) for most adults ≤75 years of age with atherosclerotic cardiovascular disease (ASCVD). For adults &gt;75 years of age with ASCVD, the guidelines recommend continuation of tolerated statins or initiation of moderate intensity statins for most patients. Objective: To examine whether guideline concordant use of high-intensity statins following myocardial infarction (MI) among Medicare beneficiaries differed by hospital size, medical school affiliation, and region of the US in 2014 (after publication of the guidelines). Methods: We identified 28,086 Medicare beneficiaries with fee-for-service and pharmacy coverage who filled a statin within 30 days following hospital discharge for MI in 2014. The analyses were restricted to 731 hospitals with at least 20 beneficiaries discharged for MI in 2014. Hospital size and medical school affiliation were determined from the American Hospital Association survey. In subgroups ≤75 and &gt;75 years of age, we calculated the proportion of beneficiaries whose first statin fill after MI was a high-intensity statin by hospital, hospital size, medical school affiliation, and region. Results: Among statin users ≤75 years of age, 10,696 (55%) beneficiaries filled a prescription for a high-intensity statin following MI. The percentage filling high-intensity statins range from 0-100% (25 th percentile 39%, 75 th percentile 69%) across hospitals. High-intensity statin use was more common following hospitalization at larger hospitals, hospitals with medical school affiliations, and those in New England ( Figure ). A lower percentage of Medicare beneficiaries &gt;75 years of age filled high-intensity statins (n = 8,441, 44%), but patterns were similar across hospital characteristics and region. Conclusions: Similar patterns of high-intensity statin use were present among individuals ≤75 years of age, in whom high-intensity statin use is guideline concordant, and individuals &gt;75 years of age, in whom high-intensity statin use is not necessarily guideline concordant, suggesting that variation in high-intensity statin prescriptions may not be directly related to close adherence to guidelines.

Prospective Utility Study of Patients with Multiple Cardiovascular Events

Objectives The effects of acute coronary syndrome (ACS) events on health-related quality-of-life (HRQoL) and the time dependency of these effects are unknown. This study aimed to characterize health utilities in ACS patients to aid development of future economic models estimating the cost per quality-adjusted life-year impact of ACS events and potential treatments. Methods Multi-center, non-interventional, longitudinal evaluation of health utility in patients experiencing ACS or stroke events. EuroQol-5 dimension 3 level (EQ-5D-3L) surveys were sent to patients (≥18 years) from three UK centers, 1 month after hospital discharge for myocardial infarction (MI), unstable angina (UA), or stroke. Patient demographics, lifestyle, and baseline utility score were collected in the first survey. Follow-up surveys were sent at 6, 12, 18, and 24 months to prospectively capture utility and subsequent health events. Two methods of patient identification were adopted-prospective, where the patient's qualifying events occurred after the study index date, and retrospective, where the patient's qualifying event occurred prior to the study index date. General healthy population utility values were assumed for pre-event HRQoL. Results Between January 2011 and March 2014, 2,103 prospectively (n = 1,350)/retrospectively (n = 753) identified patients (mean age = 68.3 years; 67.9% male) responded: MI = 55.9% (n = 1,176), UA = 42.7% (n = 898), stroke = 1.4% (n = 29); 24% had type 2 diabetes. Post-event utility values were lower than general healthy population values, although significant differences in utility between subsequent 6 (n = 1,031, change = -0.002), 12 (n = 1,096, change = -0.008), 18 (n = 1,246, change = -0.007), and 24 (n = 1,277, change = -0.004) month timepoints were not detected. Through multivariate regression analyses, wheelchair use, current smoking, and secondary mental and joint health events were associated with the greatest statistically significant utility decrements. Conclusions This study indicates that health utility decreases following a cardiovascular event and, although some improvement occurs over the subsequent 24 months, general healthy population utility is not necessarily attained.

The effect of self-efficacy enhancement program on medication adherence among post-acute myocardial infarction

Aim and backgroundStudies have reported that adherence to medications after hospital discharge for myocardial infarction is poor with about 12% to 20% of patients discontinue their medications six months after discharge. This study aimed to examine the effect of self-efficacy enhancement program on medication adherence in post-acute myocardial infarction patients. MethodsA total 44 patient with post-acute myocardial infarction were recruited from the in-patient department, Police General Hospital. The participants were random assigned into control group and experimental group. The control group received conventional care while the experimental group attended a four-week self-efficacy enhancement program, which included motivation, skill practice, and monitoring skills. The mean self-efficacy score between groups was assessed. The pill count was used to measure medication adherence. Correlations between self-efficacy and medication adherence were examined. Data were analyzed using descriptive statistic, Pearson's correlation, and t-test. ResultsThe mean score on medication adherence of the experiment group who attended the self-efficacy enhancement program was significantly greater than the control group (t=−2.77; df=21; p=0.01). The mean scores of self-efficacy between the experimental and control group were 35.73 (SD=4.11) and 35.41 (SD=3.78). The correlations between self-efficacy and medication adherence were significantly (r=1.00, p=0.00). ConclusionThe effectiveness of self-efficacy enhancement program was effective in improving medication adherence in Thai post-acute myocardial infarction.

Kidney Function and Long-Term Medication Adherence after Myocardial Infarction in the Elderly

The association of kidney function with long-term outpatient medication adherence in the elderly remains understudied. A cohort of 2103 patients over the age of 65 years enrolled in a pharmacy benefits program after hospital discharge for myocardial infarction was studied. Using linear mixed effects models, the association of baseline kidney function with long-term adherence to recommended medications after myocardial infarction was examined, including angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), β-blockers, and statins. The primary outcome measure was the percentage of days covered as calculated by pharmacy refill data for 12 serial 3-month intervals (totaling 36 months of follow-up). Overall long-term adherence to ACEIs/ARBs, β-blockers, and statins was poor. The mean percentage of days covered by 36 months was only 50% to 60% for all three medication classes. Patients with baseline kidney dysfunction had significantly lower long-term ACEI/ARB and β-blocker adherence compared with patients with higher baseline kidney function. Long-term statin adherence did not vary by baseline level of kidney function. Long-term medication adherence after myocardial infarction in the elderly is low, especially in patients with kidney dysfunction. Future strategies to improve medication adherence should pay special attention to the elderly with kidney dysfunction because they may be especially vulnerable to its adverse clinical consequences.

The relation of stress and psychiatric illnesses to coronary heart disease

The relation of stress and psychiatric illnesses to coronary heart disease

Sex differences in 2-year mortality after hospital discharge for myocardial infarction

Younger, but not older, women who survive hospitalization for myocardial infarction have a higher long-term mortality rate than men. This finding provides additional evidence that younger women who...

Differences between Men and Women in Risk for Death after a Heart Attack

Summaries for Patients6 February 2001Differences between Men and Women in Risk for Death after a Heart AttackSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-3-200102060-00003 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What is the problem and what is known about it so far?Acute myocardial infarction, more commonly known as heart attack, is a condition in which the blood vessels that supply blood to the heart muscle become blocked. If blood flow is blocked for long enough, a part of the heart muscle dies and is replaced by scar tissue. When large areas of the heart or special areas that control heart rhythms are involved, heart attacks can be deadly. Women younger than 60 years of age are more likely than men younger than 60 years of age to die while ... Author, Article, and Disclosure InformationAffiliations: The summary below is from the full report titled “Sex Differences in 2-Year Mortality after Hospital Discharge for Myocardial Infarction.” It is in the 6 February 2001 issue of Annals of Internal Medicine (volume 134, pages 173-181). The authors are V Vaccarino, HM Krumholz, J Yarzebski, JM Gore, and RJ Goldberg.Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSex Differences in 2-Year Mortality after Hospital Discharge for Myocardial Infarction Viola Vaccarino , Harlan M. Krumholz , Jorge Yarzebski , Joel M. Gore , and Robert J. Goldberg Metrics 6 February 2001Volume 134, Issue 3Page: I-74KeywordsBlood flowBlood vesselsDeath ratesHospitalizationsLongitudinal studiesMedical risk factorsMortalityMyocardial infarctionMyocardiumScars ePublished: 6 February 2001 Issue Published: 6 February 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Sex differences in 2-year mortality after hospital discharge for myocardial infarction.

An interaction between sex and age is thought to affect hospital mortality after myocardial infarction; younger, but not older, women have been shown to have higher mortality rates than men. It is currently unknown whether findings are similar after hospital discharge. To determine whether an interaction between sex and age affects 2-year mortality after myocardial infarction. Community-based prospective cohort study. 16 community hospitals serving the Worcester, Massachusetts, metropolitan area. 6826 patients who survived hospitalization for acute myocardial infarction during ten 1-year periods between 1975 and 1995. Mortality 2 years after hospital discharge. The overall 2-year mortality rate was higher in women (28.9%) than in men (19.6%). When patients were examined by age group, however, only women younger than 60 years of age had a higher mortality rate than men of similar age. The sex difference decreased with increasing age; among the oldest patients, women had a lower mortality rate than men (P = 0.009 for the interaction between sex and age). This relationship was not affected by adjustment for demographic characteristics and medical history, clinical characteristics, and hospital and discharge treatments; the hazard of 2-year death for women compared with men increased 15.4% (95% CI, 4.3% to 27.6%) for every 10-year decrease in age. In absolute terms, after adjustment for demographic characteristics and medical history, among patients younger than 60 years of age women were at greater risk than men (risk difference, 1.8 percentage points). At older ages, however, women were at lower risk than men. Younger, but not older, women who survive hospitalization for myocardial infarction have a higher long-term mortality rate than men. This provides additional evidence that younger women with myocardial infarction are at greater risk for death than men.

Influence of exercise training soon after myocardial infarction on regional myocardial perfusion and resting left ventricular function.

There is scant information regarding the effect of exercise training begun soon after hospital discharge for myocardial infarction (MI) with respect to subsequent improvement in exercise tolerance, enhancement of regional myocardial perfusion, or left ventricular function. Accordingly, 19 post-MI patients (mean age 53 +/- 7 years) underwent treadmill exercise quantitative thallium-201 (Tl-201) scintigraphy and rest radionuclide angiography (RNA) prior to and after 12 weeks of thrice-weekly exercise training which was targeted to 70-85% of maximum exercise heart rate achieved. Training was begun at 25 +/- 3 days after hospital discharge. Eight Tl-201 scan segments were each scored from 1-6 points based upon uptake and washout criteria with 6 being the most severe defect (greater than 50% reduction in Tl-201 events with no delayed redistribution). When matched to the pretraining peak workload on exercise testing, 12 weeks of training significantly lessened heart rate (120 +/- 4 to 97 +/- 4, p less than 0.001), peak systolic blood pressure (142 +/- 6 to 129 +/- 5 mmHg, p less than 0.01), and significantly reduced double product [17.2 +/- 10.8 to 12.7 +/- 9 (x10(3), p less than 0.001]. Training was associated with a reduction of exercise-induced ST depression or angina (42 to 16%) which was not statistically significant. The mean resting by RNA ejection fraction was 50 +/- 3% prior to training and 51 +/- 3% after training. There was no significant change in overall Tl-201 defect score or the number of defect regions per patient scan comparing pre- and post-training scintigrams.(ABSTRACT TRUNCATED AT 250 WORDS)