Myocardial Infarction Data Acquisition System Research Articles

Factors influencing the indication of coronary angiography in patients presenting with chest pain unspecified: an analysis of two decades (1994-2014).

Guidelines for cardiac catheterization in patients with non-specific chest pain (NSCP) provide significant room for provider discretion, which has resulted in variability in the utilization of invasive coronary angiograms (CAs) and a high rate of normal angiograms. The overutilization of CAs in patients with NSCP and discharged without a diagnosis of coronary artery disease is an important issue in medical care quality. As a result, we sought to identify patient demographic, socioeconomic, and geographic factors that influenced the performance of a CA in patients with NSCP who were discharged without a diagnosis of coronary artery disease. We intended to establish reference data points for gauging the success of new initiatives for the evaluation of this patient population. In this 20-year retrospective cohort study (1994-2014), we examined 107 796 patients with NSCP from the Myocardial Infarction Data Acquisition System, a large statewide validated database that contains discharge data for all patients with cardiovascular disease admitted to every non-federal hospital in NJ. Patients were partitioned into two groups: those offered a CA (CA group; n = 12 541) and those that were not (No-CA group; n = 95 255). Geographic, demographic, and socioeconomic variables were compared between the two groups using multivariable logistic regression, which determined the predictive value of each categorical variable on the odds of receiving a CA. Whites were more likely than Blacks and other racial counterparts (19.7% vs. 5.6% and 16.5%, respectively; P < .001) to receive a CA. Geographically, patients who received a CA were more likely admitted to a large hospital compared to small- or medium-sized ones (12.5% vs. 8.9% and 9.7%, respectively; P < .05), a primary teaching institution rather than a teaching affiliate or community center (16.1 % vs. 14.3% and 9.1%, respectively; P < .001), and at a non-rural facility compared to a rural one (12.1% vs. 6.5%; P < .001). Lastly from a socioeconomic standpoint, patients with commercial insurance more often received a CA compared to those having Medicare or Medicaid/self-pay (13.7% vs. 9.5% and 6.0%, respectively; P < .001). The utilization of CA in patients with NSCP discharged without a diagnosis of coronary artery disease in NJ during the study period may be explained by differences in geographic, demographic, and socioeconomic factors. Patients with NSCP should be well scrutinized for CA eligibility, and reliable strategies are needed to reduce discretionary medical decisions and improve quality of care.

US Initiative to Eliminate Racial and Ethnic Disparities in Health: The Impact on the Outcomes of ST-Segment-Elevation Myocardial Infarction in New Jersey.

Background In 1998, President Clinton launched a federal initiative to eliminate racial and ethnic health disparities. The impact on the outcomes of ST-segment-elevation myocardial infarction has not been well studied. Methods and Results ST-segment-elevation myocardial infarction outcomes from 1994 to 2015 were studied in 7942 Black, 27 665 Hispanic, and 88 727 White patients with first admission of ST-segment-elevation myocardial infarction using the Myocardial Infarction Data Acquisition System. Logistic regressions were used to assess mortality adjusting for demographics, comorbidities, and interventional procedures. There was an overall rise from 1994 to 2015 in the use of percutaneous coronary interventions in all 3 groups. Before 1998, White patients received more percutaneous coronary interventions compared with Black and Hispanic patients (P<0.05). After 1998, the disparity in use of percutaneous coronary interventions in Black and Hispanic patients was greatly reduced compared with White patients, and the difference reversed in favor of Hispanic patients after 2005 (P<0.05). There was an overall downward trend of in-hospital mortality without evidence of disparity among Black, Hispanic, and White patients. A linear regression model was used with a change point in 1998. Before 1998, the slope of 1-year all-cause and cardiovascular mortality was not statistically significant. After 1998, the mortality showed negative slopes for all 3 groups, however, with lower overall crude mortality for Hispanic patients compared with Black and White patients (P<0.0001). Conclusions The initiative launched in 1998 may have contributed to a reduction in percutaneous coronary intervention usage disparity in patients with ST-segment-elevation myocardial infarction. Short- and long-term mortality decreased in all 3 groups, but more in the Hispanic population.

Abstract 10194: Acute Pericarditis in Patients With Breast Cancer - A Statewide Study

Introduction: Acute pericarditis has not been linked to long-term heart-specific morbidity in breast cancer patients. Carcinomatous pericardial involvement has been detected at autopsy in 10-20% of breast cancer patients. In clinical practice, when it comes to primarily echocardiographically-diagnosed pericardial diseases: pericardial effusion, cardiac tamponade, and pericardial constriction have all been reported in breast cancer patients. Acute pericarditis is primarily a clinical non-imaging bedside diagnosis derived from the combination of chest pain, pericardial rub, and typical electrocardiographic changes, irrespective of the presence or absence of pericardial fluid on imaging. It can be the initial clinical manifestation of a malignancy. Methods: The Myocardial Infarction Data Acquisition System (MIDAS) database is an ongoing, longitudinal, and validated database that comprises discharge data, along with demographics, comorbidities, and length of hospital stay; for all patients with cardiovascular diseases admitted to every non-federal acute care hospital in the state of New Jersey. We searched for the diagnosis of acute pericarditis (ICD-9 codes 420.0, 420.90, 420.91, and 420.99), in first hospital admissions of female patients with breast cancer (ICD-9 codes 174.0-174.9) between January 1995 to December 2015. Controls were female breast cancer patients without the diagnosis of acute pericarditis. Results: There were 60,435 female patients with breast cancer. Of those, 253 (0.4%) were also diagnosed with acute pericarditis on the same admission as the first breast cancer diagnosis, or later. Analysis for comorbidities showed that 116 (45.8%) of the 253 patients with acute pericarditis had admissions for heart failure, as opposed to 26.4% (15,895 out of 60,182) of breast cancer patients without acute pericarditis (p &lt; 0.00001). Conclusions: Since New Jersey has a diverse population that resembles the profile of the United States in age, gender, and race/ethnicity; our findings could also be generalized to other geographic areas, and may help with future clinical guidelines. Although it is rare, acute pericarditis in breast cancer patients can indicate long-term cardiovascular morbidity.

Relation of Socioeconomic Status to 1-Year Readmission and Mortality in Patients With Acute Myocardial Infarction

Cardiovascular (CV) disease accounts for 1/3 of deaths worldwide and 1/4 of deaths nationwide. Socioeconomic status (SES) affects CV health and outcomes. Previous studies that examined the association of SES and CV outcomes have yielded mixed results. Using a large-scale database, the aim of this study was to assess the magnitude of the association between categorized median household income, an indicator for SES, and nonfatal or fatal acute myocardial infarction (AMI). Using logistic regression models, zip code median household income data from the United States Census Bureau were matched to 1-year rates of hospital readmission for AMI and CV death. Patient outcomes were obtained from the Myocardial Infarction Data Acquisition System, a comprehensive database that includes all patient CV disease admissions to acute care New Jersey hospitals. Our main results indicate that compared with those in the highest household income level (>$68,000), patients in the lowest-income group (<$43,000) had significantly higher risk for AMI readmission (adjusted odds ratio 1.1388, 95% confidence interval 1.0905 to 1.1893, p=0) and CV death (odds ratio 1.0479, 95% confidence interval 1.0058 to 1.0917, p=0.0254) after 1 year. This study also found that the likelihood of AMI readmission increased as household income levels decreased. Our findings suggest that healthcare professionals and policy makers should allocate additional resources to low-income communities to reduce disparities in AMI hospital readmissions and AMI case fatalities.

Assessment of one-year risk of ischemic stroke versus major bleeding in patients with atrial fibrillation

BackgroundPatients diagnosed with atrial fibrillation (AF) are at increased risk of stroke. Several guidelines to assess the risk of ischemic stroke and major bleeding in AF patients have been published. The CHA2DS2-VASc score has been adopted widely for predicting stroke within one year of the index AF diagnosis and is used to guide the prescription of anticoagulants. Anticoagulation therapy increases the risk of bleeding and scoring systems such as HAS-BLED assess the risk of major bleeding in anticoagulated patients. Despite these advances, no study has examined the risks of the two outcomes simultaneously. How patients’ fear of particular outcomes affects these risks also remains unknown. MethodsWe incorporated the risks of ischemic stroke and major bleeding within one year of the index AF admission as well as the fear of stroke and bleeding of each individual patient. The patients enrolled in this retrospective observational study were identified using hospital admission data from the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database including all hospitalizations for cardiovascular disease in New Jersey. Probabilities of the outcomes (ischemic stroke, major bleeding, both, or neither within one year of the index AF admission) were estimated using multinomial regression with patient demographics and comorbidities (heart failure [HF], hypertension [HTN], diabetes mellitus [DM], anemia, chronic obstructive pulmonary disease [COPD], kidney disease [KD], prior stroke or transient ischemic attack [TIA]) as predictors. These estimates were used in a Deming regression to model the association of ischemic stroke and major bleeding in grouped patients. The assessment of the importance of each outcome was superimposed on the final model to arrive at a recommendation for anticoagulation therapy. ResultsThe results of the Deming regression indicated a positive relationship between ischemic stroke and major bleeding (slope = 1.67, 95% confidence interval [CI] 1.37 to 1.97). Estimates of the risks of the two outcomes and the lines of best fit from Deming regression were determined. This model for risk assessment of stroke and major bleeding within one year of the index AF hospital admission combined objective data and subjective assessment of the relative fear of stroke versus bleeding by each hypothetical patient on 0–100 scale. Examples with the fears of stroke versus major bleeding being equal (50-50) and a higher fear of stroke (80–20) are presented. ConclusionsThe new model for risk assessment of ischemic stroke and major bleeding within one year of the index AF hospital admission proposed in this work used objective, empirically driven measures, and subjective assessment of the outcomes’ importance for individual patients. Such models may assist physicians in their decision making regarding anticoagulation therapy.

Does One’s Socioeconomic Status Predispose to the Development of Stress-Induced Cardiomyopathy?

Introduction: Stress-induced cardiomyopathy (SIC) has a higher incidence in Caucasians (CAUCs) compared to African-Americans (AAs). Whether this is due to racial predisposition, selection bias, or environmental factors remains unclear. Hypothesis: We hypothesize that people from lower socioeconomic strata (SES) have a lower incidence of SIC. It is possible that the incidence of SIC could be similar among CAUCs and AAs at the same SES. Stress preconditioning maybe protective in preventing SIC. Methods: Data of patients with the discharge diagnosis of SIC were extracted from the Myocardial Infarction Data Acquisition System spanning the period from 2006 through 2015. The incidence of SIC among CAUCs and AAs was compared per 100,000 New Jersey population and examined across income brackets. CAUCs and AAs data were compared using two-sample proportion tests. Results: During the study period, CAUCs had an overall higher incidence of SIC compared to AAs, 0.017% versus 0.0084% per 100,000 population (p value <0.0001). This difference persisted after a logistic regression adjustment (p = 0.0064). CAUCs in the income brackets of 30–40k had lower incidence of SIC than those in the 60–80k income bracket (p = 0.0156). Those with an income of 60–80k had lower incidence of SIC compared to those with an income of 80–100k. AAs with income between 30 and 60k had a lower incidence of SIC than CAUCs (p = 0.0330). Conclusions: CAUCs exhibited a trend towards less SIC as a function of lower income. This was not observed among AAs. AAs had a lower incidence of SIC. Our study suggests that SES has a protective effect among CAUCs.

A Statewide Study of Cardiovascular Outcomes in Patients with Ankylosing Spondylitis

Numerous studies have shown that ankylosing spondylitis is associated with an increased risk of cardiovascular disease including heart failure, acute myocardial infarction, stroke, transient ischemic attack, and cardiovascular mortality. This may be a direct result of inflammation or an indirect one from the use of anti-inflammatory drugs needed to treat ankylosing spondylitis, or from the coexistence of traditional risk factors. This is a retrospective case-control study of the occurrence of cardiovascular events in ankylosing spondylitis patients and matched controls. Data was obtained from the Myocardial Infarction Data Acquisition System, a statewide database containing hospitalizations for cardiovascular diseases in New Jersey. Two types of analyses were performed: unadjusted and adjusted for comorbidities. The odds ratio of developing heart failure in the ankylosing spondylitis group vs. matched controls was 1.59 (95% CI 1.44 - 1.76, p &lt; 0.001) in the unadjusted model and 1.31 (95% CI 1.18 - 1.47, p &lt; 0.001) after adjustment for hypertension, diabetes mellitus, acute kidney failure/chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, and hyperlipidemia. Similarly, risks of myocardial infarction and cardiovascular mortality in ankylosing spondylitis patients were significantly higher in both, unadjusted and adjusted models while odds ratio for transient ischemic attack became non-significant after the adjustment. Ankylosing spondylitis is associated with increased rates of the cardiovascular disease that are probably due of pathophysiologic changes attendant to the disease, as well as the presence of the comorbidities.

Abstract 12361: Yelp Data on Fast Food and Exercise Facilities Predict Cardiovascular Events

Introduction: Yelp includes information on nearly all businesses and socioeconomic data in any region of the United States. This database maybe used to obtain socio-economic data that may affect the incidence of cardiovascular disease. This project focuses on access to poor quality food such as fast food and lack of exercise that may have a negative impact in cardiovascular disease. A dataset including the number of fast-food restaurants, non-fast-food restaurants, grocery stores, gyms, other fitness facilities, nursing homes, and pharmacies were aggregated by zip code. In addition, demographic variables such as gender, age, and comorbidities were included. Cardiovascular outcomes were obtained from the Myocardial Infarction Data Acquisition System (MIDAS) database of all hospitalizations in New Jersey. Ten percent of the zip codes that did not have sufficient data were excluded. Hypothesis: Yelp variables will predict the occurrence of stroke, myocardial infarction and heart failure requiring hospitalization. Methods: The yelp data were used to predict three outcomes as identified by the MIDAS database: stroke, myocardial infarction and heart failure requiring hospitalization. Linear models followed by stepwise selection of the predictors were used to define the final models used in these analyses. Results: The results of the regressions in the table show that the number of fast-food restaurants and nursing homes were associated with increased frequency of all 3 outcomes controlling for population size. Access to grocery stores, gyms, and other fitness facilities are associated with lower rate of stroke, myocardial infarction and heart failure requiring hospitalization. Conclusions: Socioeconomic variables obtained from the yelp database predicted the occurrence of stroke, myocardial infarction and heart failure requiring hospitalization with high degree of accuracy.

Abstract 13362: Patient-centered Assessment Of Risk Of Stroke Vs. Bleeding In Patients With Atrial Fibrillation

Introduction: Clinicians use CHA 2 DS 2 -VASc to predict stroke at one year and HAS-BLED to predict bleeding at one year in patients with atrial fibrillation. However, the scores do not consider the fear of the two outcomes in the individual patient. Hypothesis: A new algorithm predicting the relative risk of stroke versus bleeding at one year implemented as a web application will classify individual patients with high degree of precision. Methods: Using the Myocardial Infarction Data Acquisition System (MIDAS) database, we developed an algorithm that considers the preferences of each individual patient as estimated from data from history in predicting the risk of bleeding or stroke from CHA 2 DS 2 -VASc and HAS-BLED. Given the patient demographics and comorbidities, the confidence intervals of predicted risks of the outcomes were first obtained by fitting a multinomial regression model. The estimates were fed into a Deming regression model to correlate the risks of the outcomes in subgroups of patients with similar risk factors. The line of best fit between the two outcomes represented the objective relationship between the outcomes. Each patient would state their fears of the outcomes on a 0 to 100 scale and adding up to 100, e.g. 20 vs. 80 for fear of stroke vs. fear of bleeding respectively. A prediction region around the line of best fit was then calculated based on the patient’s fears. Results: Based on the predicted risks of stroke and bleeding and the patient’s fears of bleeding, the algorithm produces a graph with two regions corresponding to whether the patient should be treated with anticoagulants. Thus, patients who feared stroke more than bleeding would be more likely to receive anticoagulation compared to a decision based on objective data. Conclusions: The algorithm shown in the figure and implemented as a web application helps clinicians make decisions on whether to prescribe anticoagulants or not based on objective data modified by individual patient preferences.

Abstract 9917: Stroke Survivors with Asthma Have Worse Cardiovascular Outcomes

Introduction: Studies have shown that asthmatics have higher risk for cardiovascular (CV) disease and all-cause mortality than non-asthmatics. However, only a few studies have examined the role asthma has on CV outcomes of stroke survivors. Hypothesis: Stroke survivors with asthma have higher risk of CV outcomes (1- and 5-year all-cause mortality, 1- and 5-year admission for stroke recurrence, first occurrence of MI, or HF) than matched stroke survivors without asthma. Methods: A total of 271,260 patients, 18-years-old and older, with index stroke and without a history of HF, MI, or COPD from January 1, 1995 to December 31, 2015 were identified in the Myocardial Infarction Data Acquisition System, a database of all admissions to non-federal hospitals in New Jersey. A matched analysis was performed by separating the cohort into asthmatics (n=11,702) and non-asthmatics (n=34,950) and matched 1 asthmatic up to 3 non-asthmatics. Data was analyzed by matching patient and clinical characteristics. The association of asthma with each of the above outcomes was assessed using logistic regression, log-rank test, and Cox models. Results: There was no difference in 1-and 5-year all-cause mortality (p=0.102 and p=0.488, respectively). Patients with asthma were more likely to be readmitted for stroke within 1 year (hazard ratio (HR)= 1.08, 95% CI 1.00-1.16, p=0.041) and had first admission for HF at 1 year (HR 1.38, 95% CI 1.09-1.73, p=0.006) compared to matched controls. Also, they were more likely to be readmitted for stroke within 5 years (HR 1.08, 95% CI 1.02-1.15, p=0.007) and to be admitted for first HF within 5 years (HR 1.27, 95% CI 1.12-1.44, p&lt;0.001) (Figure). There were no significant differences in 1-year and 5-year first MI admissions. Conclusion: Stroke survivors with asthma have higher risk for stroke readmission and first HF admission compared to matched controls. Randomized studies are needed to confirm these findings and stimulate focused efforts to mitigate this risk.

Socioeconomic data predict adverse cardiovascular outcomes

Abstract Background/Introduction Socioeconomic status (SES) factors predict the occurrence of adverse cardiovascular (CV) outcomes. Purpose SES has been studied in many contexts. We present data on SES in a new context using yelp, an American public company that publishes crowd-sourced reviews about businesses. A dataset containing aggregated yelp data for New Jersey zip codes pertaining to the number of fast-food restaurants, grocery stores, gyms and other fitness centers, nursing homes, and pharmacies was created. Cardiovascular outcomes were obtained from the Myocardial Infarction Data Acquisition System (MIDAS). Methods Linear regression models of the SES factors were used to predict the occurrence of hospitalized stroke, myocardial infarction (MI), and heart failure (HF). Results Overall, the number of fast-food restaurants, grocery stores, nursing homes, and pharmacies were associated with increased rate of adverse CV outcomes, while gyms and other fitness centers were associated with improved outcomes. Also, the SES factors of grocery, nursing home, pharmacy and fast-food restaurants were associated with increased rate of MI (p&amp;lt;0.0001). In addition, the SES factors of grocery, nursing home, pharmacy and fast food were associated with increased rate of HF (p&amp;lt;0.0001). On the contrary, gyms and other fitness centers were associated with lower rate of CV outcomes (p&amp;lt;0.0001). With respect to stroke, the SES factors of grocery, nursing home, pharmacy and fast-food restaurants were associated with increased rate of this condition (p&amp;lt;0.0001, figure). The y axis of the figure is proportional to the square root of the number of strokes in each zip code per 10,000 people. Conclusions In conclusion, persons living in zip codes of low socioeconomic status are associated with a high rate of occurrence of MI, HF and stroke. The number of gyms and other fitness centers is associated with a low rate of these outcomes. This information may be important in designing and implementing preventive strategies. Funding Acknowledgement Type of funding sources: None.

Multivariate survival analysis in big data: A divide-and-combine approach.

Multivariate failure time data are frequently analyzed using the marginal proportional hazards models and the frailty models. When the sample size is extraordinarily large, using either approach could face computational challenges. In this paper, we focus on the marginal model approach and propose a divide-and-combine method to analyze large-scale multivariate failure time data. Our method is motivated by the Myocardial Infarction Data Acquisition System (MIDAS), a New Jersey statewide database that includes 73,725,160 admissions to nonfederal hospitals and emergency rooms (ERs) from 1995 to 2017. We propose to randomly divide the full data into multiple subsets and propose a weighted method to combine these estimators obtained from individual subsets using three weights. Under mild conditions, we show that the combined estimator is asymptotically equivalent to the estimator obtained from the full data as if the data were analyzed all at once. In addition, to screen out risk factors with weak signals, we propose to perform the regularized estimation on the combined estimator using its combined confidence distribution. Theoretical properties, such as consistency, oracle properties, and asymptotic equivalence between the divide-and-combine approach and the full data approach are studied. Performance of the proposed method is investigated using simulation studies. Our method is applied to the MIDAS data to identify risk factors related to multivariate cardiovascular-related health outcomes.

Constrictive Pericarditis after Open Heart Surgery: A 20-Year Case Controlled Study

BackgroundConstrictive pericarditis is a rare complication of open heart surgery (OHS), but little is known regarding the etiologic determinants, and prognostic factors. The purpose of this study was to investigate clinical predictors and long term prognosis of post-operative constrictive pericarditis (CP). MethodsUsing the Myocardial Infarction Data Acquisition System database, we analyzed records of 142,837 patients who were admitted for OHS in New Jersey hospitals between 1995 and 2015. Ninety-one patients were hospitalized with CP 30 days or longer after discharge from OHS. Differences in proportions were analyzed using Chi square tests. Controls were matched to cases for demographics, surgical procedure type, history of OHS, and propensity score. Cox proportional hazard models were used to evaluate the risk of all-cause death. Log-rank tests and Cox models were used to assess differences in the Kaplan-Meier survival curves with and without adjustments for comorbidities. ResultsPatients with CP were more likely to have history of valve disease (VD, p < 0.001), atrial fibrillation (AF, p = 0.024) renal disease (CKD, p = 0.028), hemodialysis (HD, p = 0.008), previous OHS (p < 0.001). Patients with CP compared to matched controls had a higher 7-year mortality (p < 0.001). This difference became statistically significant at 1-year after surgery. ConclusionCP is a rare complication of OHS that occurs more frequently in patients with VD, AF, CKD, HD, multiple OHS, and it is associated with an unfavorable long-term prognosis. Given the large number of OHS performed every year, the results highlight the need for clinicians to recognize and properly manage this complication of OHS.

Abstract 13615: Weekdays versus Weekends: Outcomes of Cardiogenic Shock in the Setting of Acute Myocardial Infarction

Introduction: Acute myocardial infarction (AMI) accounts for the majority of patients with cardiogenic shock (CS). The high case fatality justifies the need for an optimal hospital care system that is available 24 hours, 7 days a week. It is unclear whether the “weekend effect” has an impact on the outcome of CS associated with AMI. Hypothesis: Weekend CS-AMI admissions have a higher in-hospital case fatality than weekday admissions. Methods: A total of 22,632 patients with ST segment elevation AMI complicated with CS between the years 1986 to 2015 were identified in the Myocardial Infarction Data Acquisition System, a statewide database of all admissions to non-federal hospitals in NJ. Trend analysis was performed using a logistic regression model with admission year as a continuous variable. Case fatality rates between weekend vs weekday admissions were compared using the Cochran–Mantel–Haenszel test, stratifying by admission year. Results: From 1986 to 2015 there was a steady decline in the rates of in-hospital case fatality of AMI complicated with CS, from 79% to 33% (p&lt; 0.001). The overall CS death rate for admissions on weekends was 61% and for weekdays 59% (Common-Odds Ratio = 1.10 (95% CI (1.02-1.17) p= 0.006) (figure). The use of mechanical circulatory support (MCS) was lower on weekends (p&lt;0.001) and was associated with a higher case fatality rate 48 hours from admission (p&lt;0.001). Conclusion: Deaths related to CS complicating AMI have steadily declined and this applies for both, patients admitted on weekends and weekdays. There was a higher hospital death rate in patients admitted over weekends compared to weekdays. The underutilization of MCS devices during weekends likely contributes to the difference in case fatality between weekends and weekdays.

The role of public health versus invasive coronary interventions in the decline of coronary heart disease mortality

Purpose: There has been considerable debate on the extent to which the decline in coronary heart disease (CHD) mortality has been caused by better control of coronary risk factors in the general population or is the result of invasive coronary interventions in symptomatic individuals. MethodsUsing the Myocardial Infarction Data Acquisition System, a statewide database of all cardiovascular hospital admissions in New Jersey, we examined time trends in incidence of death from CHD in the Years 2000–2014 in persons with a history of hospitalization for CHD in the previous 10 years and those without such a history. ResultsOver the 10-year study period, there was a marked decline in CHD-related mortality in both persons with a history of CHD and persons without a history of CHD. The decline occurred across all gender, racial, and age groups and was higher in those without a prior history of CHD. ConclusionsThis adds more evidence that the decline in CHD was not only because of advanced invasive medical and surgical treatments but also equally because of improved lifestyle, pharmacologic treatment of risk factors for CHD, and public health interventions.

Readmission and mortality among heart failure patients with history of hypertension in a statewide database.

Objective was to examine the temporal trends in readmission and mortality of heart failure (HF) patients with history of hypertension. This study includes 51141 patients with history of hypertension who were discharged with a first diagnosis of HF between January 1, 2000, and December 31, 2014. Data were obtained from the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all hospitalizations for cardiovascular (CV) disease in New Jersey. The temporal trends of mortality, rates of HF-specific readmission, and all-cause readmissions up to 1year after discharge were examined using multivariable logistic regression. The difference in all-cause mortality at 3years between patients who were readmitted compared to those who were not readmitted at 1year was examined. The number of patients with history of hypertension and HF remained unchanged during the study period. Male gender, black race, comorbidities, and admission to non-teaching hospitals were predictors of HF readmission and CV mortality (P<.05 for all). Readmission rate for any cause increased during the study period (P<.001) while rates of HF readmissions and mortality remained relatively unchanged. Patients that had been readmitted within a year exhibited a significantly higher 3-year mortality (P<.001). CV mortality among HF patients with history of hypertension did not change significantly between 2000 and 2014, while the rates of all-cause readmission increased. Patients who were readmitted had higher 3-year mortality (P<.001) than those who were not.

Trends in Hospitalization Rates for A First Myocardial Infarction In New Jersey 2000-2014

There has been a remarkable decline in the incidence of myocardial infarction (MI) for the past several decades. However, scant data are available on whether this decline has increased, diminished, or remained stable in recent years. Using the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all cardiovascular hospital admissions in New Jersey, we identified 168,966 patients with a primary diagnosis of MI. We examined time trends in incidence from the year 2000 to the year 2014. A steep decline in MI incidence was observed in all age groups with an overall decline of 30.2% over the period. The decline was seen in all age groups but was most pronounced in the 80-84 age group. Hispanics had the greatest decline followed by whites and finally blacks. Males had a greater decline than females. The decline was seen to level off after 2008. This remarkable pattern of incidence decline may be related to the increase in use of interventional and pharmacological therapies that plateaued after 2008. In conclusion, this study shows a decline in MI incidence that leveled off after 2008.

P1836Constrictive pericarditis after open heart surgery: a 20-year case controlled study

Abstract Background Constrictive pericarditis (CoPe) after open-heart surgery (OHS) is a rare complication. Information on the incidence, determinants, and prognosis of this condition has been scarcely reported. Purpose To investigate the long term prognosis of CoPe after OHS. Methods Using the Myocardial Infarction Data Acquisition System database, we analyzed records of 144,902 patients that had OHS in New Jersey hospitals between 1995 and 2015. CoPe was identified in 79 patients after discharge. Differences in proportions were analyzed using chi square. Cases and controls were matched for demographics and comorbidities. Cox proportional hazard models were used to evaluate outcome risks. Log-rank test was used to assess differences in the Kaplan-Meier survival curves. Results Patients with CoPe were more likely to have history of valve disease (HVD) (p&lt;0.0001), atrial fibrillation (AF) (p=0.0006) and chronic kidney disease (CKD) (p=0.012). Significant predictors of CoPe were AF (HR 1.62, 95% CI 1.02–2.59), CKD (HR 2.70, 95% CI 1.53–4.76), diabetes (HR 1.73, 95% CI 1.08–2.80) and HVD (HR 3.11, 95% CI 1.88–5.15). Patients with CoPe compared to matched controls had a higher 10-year mortality (p&lt;0.0001). This became a statistically significant difference at 6 years after surgery (Figure). Survival Curve Conclusion Constrictive pericarditis is a rare complication of OHS and occurs more frequently in patients with AF, CKD, diabetes and HVD. It is associated with an unfavorable long-term prognosis. The data highlight the need for strategies to help prevent this complication. Acknowledgement/Funding Robert Wood Johnson Foundation

P4574Marked changes in the incidence of subendocardial and ST elevation myocardial infarctions: a twenty-one year study

Abstract Background/Introduction The use of new biomarkers, pharmacologic and interventional therapies have resulted in marked changes of the type of myocardial infarction. Purpose The purpose of this study is to report on the changes in the incidence of subendocardial and ST elevation myocardial infarctions (STEMI) in the state of New Jersey from 1994 to 2015 and describe possible explanations for this secular change. Methods The rate of occurrence of ST elevation myocardial infarction (ICD9 410.00) and of subendocardial (NSTEMI, ICD9 410.70 to 410.72) myocardial infarction was studied using the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all admissions for acute myocardial infarction in New Jersey with more than 30 years longitudinal follow up. Admissions for myocardial infarction and unstable angina as well as for conditions associated with troponemia (heart failure ICD9 418.XX, chronic kidney disease ICD9 584.XX, 585.XX, 403.XX, diabetes ICD9 250.XX) were also identified. Associations among variables were examined using logistic regression and linear error in variables (LEIV) models. Results During the time period under consideration, there was a decrease in the total number of MIs in New Jersey by 17.5%, the number of STEMIs decreased by 67.4%, while the rate of NSTEMIs increased by 85.8% (top panel). There was a complementary relationship between the annual number of admissions for unstable angina to the annual number of admissions for NSTEMIs (bottom panel). The effect was more pronounced between 1994 and 2002 and plateaued thereafter corresponding to widespread use of troponins in the diagnosis of acute coronary syndromes. Conclusions The marked change in the type of myocardial infarction was due in part to the use of troponins that resulted in the classification of patients with unstable angina as patients with subendocardial infarction. These data support regionalization of facilities specializing in immediate intervention in STEMI patients.

Preeclamptic Women Are at Significantly Higher Risk of Future Cardiovascular Outcomes Over a 15-Year Period.

Background: Preeclampsia (PE) may lead to maternal and infant mortality and severe medical complications. Understanding future short- and long-term cardiovascular (CV) outcomes of PE is important to women's health. Materials and Methods: A retrospective matched case-control study assessed the risks of CV outcomes over a 15-year period (1999-2013) in pregnant case women, with gravidity and parity of one, diagnosed with PE, compared to pregnant primiparous control women who were not diagnosed with PE. The New Jersey Electronic Birth Certificate (EBC) database and the Myocardial Infarction Data Acquisition System (MIDAS), a database of all hospital admissions in New Jersey with longitudinal follow-up, were used to conduct the analysis. Participants were 18 years and older with demographics consistent with New Jersey, a state with a range of racial and ethnic diversity. Main outcome measures postpregnancy and over this 15-year period were myocardial infarction (MI), stroke, CV death, and all-cause death. Results: Women with PE (N = 6,360) were more likely to suffer MI, stroke, CV death, and all-cause death than controls (N = 325,347). After matching cases to controls for demographics and comorbidities, hazard ratios of PE cases for the outcomes of MI (p adjusted for comorbidities and demographics = 0.0196), CV death (adjusted p = 0.007), and all-cause death (adjusted p = 0.0026) were significantly higher than 1 compared to matched controls. Women with PE had 3.94 (95% CI: 1.25-12.4) times higher hazard for MI, 4.66 (95% CI: 1.52-14.26) times higher hazard of CV death, and 2.32 (95% CI: 1.34-4.02) times higher hazard for all-cause death than matched controls. Conclusions: This 15-year study indicates that women who have PE with their first pregnancy have a significantly higher risk of adverse CV outcomes compared to controls and suggest a heightened and continued CV monitoring after birth for this population of women.