Myocardial Infarction In England Research Articles

Forecast of myocardial infarction incidence, events and prevalence in England to 2035 using a microsimulation model with endogenous disease outcomes.

Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all MI rates emerge from competing trends in risk factors and treatment. microPRIME is a microsimulation of MI events within a sample of 114,000 agents representative of England. We simulate 37 annual time points from 1998 to 2035, where agents can have an MI event, die from an MI, or die from an unrelated cause. The probability of each event is a function of age, sex, BMI, blood pressure, cholesterol, smoking, diabetes and previous MI. This function does not change over time. Instead population-level changes in MI rates are due to competing trends in risk factors and treatment. Uncertainty estimates are based on 450 model runs that use parameters calibrated against external measures of MI rates between 1999 and 2011. Forecasted MI incidence rates fall for men and women of different age groups before plateauing in the mid 2020s. Age-standardised event rates show a similar pattern, with a non-significant upturn by 2035, larger for men than women. Prevalence in men decreases for the oldest age groups, with peaks of prevalence rates in 2019 for 85 and older at 25.8% (23.3-28.3). For women, prevalence rates are more stable. Prevalence in over 85s is estimated as 14.5% (12.6-16.5) in 2019, and then plateaus thereafter. We may see an increase in event rates from MI in England for men before 2035 but increases for women are unlikely. Prevalence rates may fall in older men, and are likely to remain stable in women over the next decade and a half.

Long-term trends in population-based hospitalisation rates for myocardial infarction in England: a national database study of 3.5 million admissions, 1968–2016

AimTo analyse the timing and scale of temporal changes in rates of hospitalised myocardial infarction (MI) in England by age and sex from 1968 to 2016.MethodsMI admissions for adults aged...

Effect of Location on Treatment and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in England & Wales

We investigated the incidence,management, and outcomes of acute myocardial infarction (AMI) patients according to cardiac arrest location. Patients admitted with a diagnosis of AMI between January 1, 2010 to March 31, 2017 from the Myocardial Ischaemia National Audit Project (MINAP) were studied. We used logistic regression modelsto evaluate predictors of the clinicaloutcomes andtreatment strategy. The study population consisted of 580,796 patients admitted with AMI stratified into three groups: out of hospital cardiac arrest (OOHCA) (16,278[2.8%]), in-hospital cardiac arrest (IHCA) (21,073[3.7%]), plus a reference group consisting of those without cardiac arrest (non-cardiac arrest (543,418[93.5%]). IHCA declined steadily (from 666 per 1000 in 2010 to 477 per 1000 AMI with cardiac arrest admissions in 2017) with a commensurate rise in OOHCA (from 344 per 1000 to 533 per 1000 AMI with cardiac arrest admissions). Coronary angiography utilization(OOHCA 81.1% vs IHCA 60.3% vs non-cardiac arrest 70.4%, p < 0.001) and PCI (OOHCA 40% vs IHCA 32.8% vs non-cardiac arrest 45.2%, p < 0.001) were higher in OOHCA. In-hospital mortality odds were greatest for IHCA (OR 35.3, 95% CI 33.4-37.2) compared to OOHCA (OR 12.7, 95% CI 11.9-13.6), with the worse outcomes seen in patients on medical wards (OR 97.37, 95% CI 87.02-108.95) and the best outcomes seen in the emergency department (OR 8.35,95% CI 7.32-9.53). In conclusion, outcomes of AMI complicated by cardiac arrest depended on cardiac arrest location, especially the outcomes of the IHCA.

Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out-of-Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England.

BackgroundStudies have reported significant reduction in acute myocardial infarction–related hospitalizations during the coronavirus disease 2019 (COVID‐19) pandemic. However, whether these trends are associated with increased incidence of out‐of‐hospital cardiac arrest (OHCA) in this population is unknown.Methods and ResultsAcute myocardial infarction hospitalizations with OHCA during the COVID‐19 period (February 1–May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre–COVID‐19 period (February 1–May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID‐19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID‐19 period compared with the pre–COVID‐19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39–1.74). Patients experiencing OHCA during COVID‐19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST‐segment–elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P<0.001) were significantly lower among the OHCA group during COVID‐19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P=0.05) in those with ST‐segment–elevation myocardial infarction. The adjusted in‐hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID‐19 group (P<.001).ConclusionsIn this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID‐19 period paralleled with reduced access to guideline‐recommended care and increased in‐hospital mortality.

The relationship between off-hours admissions for primary percutaneous coronary intervention, door-to-balloon time and mortality for patients with ST-elevation myocardial infarction in England: a registry-based prospective national cohort study

BackgroundThe degree to which elevated mortality associated with weekend or night-time hospital admissions reflects poorer quality of care (‘off-hours effect’) is a contentious issue. We examined if off-hours admissions for...

Seasonal variation in mortality secondary to acute myocardial infarction in England and Wales: a secondary data analysis

BackgroundAcute myocardial infarction (AMI) is a leading cause of death globally. Increase in AMI mortality during winter has also been identified in existing literature. This has been associated with low...

Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort.

BackgroundThere is limited knowledge of the scale and impact of multimorbidity for patients who have had an acute myocardial infarction (AMI). Therefore, this study aimed to determine the extent to which multimorbidity is associated with long-term survival following AMI.Methods and findingsThis national observational study included 693,388 patients (median age 70.7 years, 452,896 [65.5%] male) from the Myocardial Ischaemia National Audit Project (England and Wales) who were admitted with AMI between 1 January 2003 and 30 June 2013. There were 412,809 (59.5%) patients with multimorbidity at the time of admission with AMI, i.e., having at least 1 of the following long-term health conditions: diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, cerebrovascular disease, peripheral vascular disease, or hypertension. Those with heart failure, renal failure, or cerebrovascular disease had the worst outcomes (39.5 [95% CI 39.0–40.0], 38.2 [27.7–26.8], and 26.6 [25.2–26.4] deaths per 100 person-years, respectively). Latent class analysis revealed 3 multimorbidity phenotype clusters: (1) a high multimorbidity class, with concomitant heart failure, peripheral vascular disease, and hypertension, (2) a medium multimorbidity class, with peripheral vascular disease and hypertension, and (3) a low multimorbidity class. Patients in class 1 were less likely to receive pharmacological therapies compared with class 2 and 3 patients (including aspirin, 83.8% versus 87.3% and 87.2%, respectively; β-blockers, 74.0% versus 80.9% and 81.4%; and statins, 80.6% versus 85.9% and 85.2%). Flexible parametric survival modelling indicated that patients in class 1 and class 2 had a 2.4-fold (95% CI 2.3–2.5) and 1.5-fold (95% CI 1.4–1.5) increased risk of death and a loss in life expectancy of 2.89 and 1.52 years, respectively, compared with those in class 3 over the 8.4-year follow-up period. The study was limited to all-cause mortality due to the lack of available cause-specific mortality data. However, we isolated the disease-specific association with mortality by providing the loss in life expectancy following AMI according to multimorbidity phenotype cluster compared with the general age-, sex-, and year-matched population.ConclusionsMultimorbidity among patients with AMI was common, and conferred an accumulative increased risk of death. Three multimorbidity phenotype clusters that were significantly associated with loss in life expectancy were identified and should be a concomitant treatment target to improve cardiovascular outcomes.Trial registrationClinicalTrials.gov NCT03037255.

An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors

ObjectivesTo investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care...

Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study

Objective To determine the completeness and diagnostic validity of myocardial infarction recording across four national health record sources in primary care, hospital care, a disease registry, and mortality register. Design...

021 IS THERE A NEED FOR SPECIALIST CARDIAC CARE FOR PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION? AN ANALYSIS OF 85 780 PATIENT EPISODES FROM THE MINAP DATABASE 2008–2009:

<h3>Background</h3> A previous analysis of the MINAP database in 2004/2005 indicated that patients admitted to hospital with myocardial infarction in England and Wales experienced better outcomes when cared for by specialist cardiology teams. Since then, routine care of ST-elevation myocardial infarction (STEMI) has been devolved wholly to cardiologists with the advent of primary PCI networks, and dissemination of clear guidance from NICE and the ESC for post-infarct patients that is readily available to all physicians has led to a move to downgrade/decommission coronary care units in some hospitals given a perceived lack of need. <h3>Methods</h3> All patients presenting to hospitals in England and Wales 2008–2009 with non-STEMI (nSTEMI) recorded in the MINAP dataset (n=85 780) were included; outcomes analysed included access to specialist acute cardiac care units (ACCU; dedicated coronary care units or cardiology wards) and coronary angiography, provision of secondary preventative medications, length of hospital stay and mortality. <h3>Results</h3> 47% of nSTEMI cases (39 674/85 780) were admitted under specialist cardiology care compared with 36% in 2004–2005. When hospitals were divided by proportion of nSTEMI admissions to ACCU, access to coronary angiography was higher and median length of stay lower incrementally by quartile (table). When adjusted for confounding variables (age, sex, relevant comorbidities), relative risk of hospital stay less than overall median compared with Q1 was: Q2 1.21 (95% CI 1.8 to 1.3), Q3 1.32 (95% CI 1.3 to 1.4) and Q4 1.62 (95% CI 1.6 to 1.7; all comparisons p&lt;0.001). Prescription of appropriate secondary preventative medications was better for patients admitted to ACCU (ORs: aspirin 1.56, 95% CI 1.2 to 2.0, p&lt;0.001; β-blocker 1.21, 95% CI 1.1 to 1.4, p&lt;0.005; ACE inhibitor 1.36, 95% CI 1.2 to 1.5, p&lt;0.0001; statin 1.23, 95% CI 1.0 to 1.5, p&lt;0.05) with the exception of clopidogrel, which was similar (OR 1.11, 95% CI 0.9 to 1.3, p=0.1). Unadjusted crude mortality was lowest for hospitals admitting the highest proportion of patients to ACCU (table). Relative risk of death within 30 days after adjustment for confounding variables for patients admitted with nSTEMI to ACCU compared with general medical facilities was 0.88 (95% CI 0.8 to 0.9; p&lt;0.001). <h3>Conclusions</h3> Despite improved care for patients with STEMI in England and Wales, the need for specialist cardiac care for patients with nSTEMI is mandated in terms of economy (length of stay), quality of care (medication provision) and clinical governance (mortality). Patients with nSTEMI should therefore universally be admitted under the care of cardiologists, in expanded ACCU facilities.

Influenza Infection and Risk of Acute Myocardial Infarction in England and Wales: A CALIBER Self-Controlled Case Series Study

Background. An association between infections and vascular events has been observed, but the specific effect of influenza and influenza-like illnesses on triggering acute myocardial infarction (AMI) is unclear.Methods. Episodes of first AMI from 1 January 2003 through 31 July 2009 were identified using linked anonymized electronic medical records from the Myocardial Ischaemia National Audit Project and the General Practice Research Database. Self-controlled case series analysis was used to investigate AMI risks after consultation for acute respiratory infection. Infections were stratified by influenza virus circulation, diagnostic code, and vaccination status to assess whether influenza was more likely than other infections to trigger AMI.Results. Of 22 024 patients with acute coronary syndrome, 11 208 met the criterion of having had their first AMI at the age of ≥40 years, and 3927 had also consulted for acute respiratory infection. AMI risks were significantly raised during days 1–3 after acute respiratory infection (incidence ratio, 4.19 [95% confidence interval, 3.18–5.53], with the effect tapering over time. The effect was greatest in those aged ≥80 years (P = .023). Infections occurring when influenza was circulating and those coded as influenza-like illness were associated with consistently higher incidence ratios for AMI (P = .012).Conclusions. Influenza and other acute respiratory infections can act as a trigger for AMI. This effect may be stronger for influenza than for other infections.Clinical trials registration. NCT01106196.

Long-Term Survival and Recurrence After Acute Myocardial Infarction in England, 2004 to 2010

There are limited population-based national data on prognosis in survivors of acute myocardial infarction (AMI), particularly on long-term survival and the risk of recurrence. Record linkage of hospital and mortality data identified 387 452 individuals in England who were admitted to hospital with a main diagnosis of AMI between 2004 and 2010 and who survived for at least 30 days. Seven years after an AMI, the risk of death from any cause in survivors of first or recurrent AMI was, respectively, 2 and 3 times higher than that in the English general population of equivalent age. For all survivors of a first AMI, the risk of a second AMI was highest during the first year and the cumulative risk increased more gradually thereafter. For men, 1- and 7-year cumulative risks were 5.6% (95% confidence interval [CI], 5.5-5.7) and 13.9% (95% CI, 13.7-14.1); for women, they were 7.2% (95% CI, 7.1-7.4) and 16.2% (95% CI, 16.0-16.5). Older age, higher deprivation, no revascularization procedures, and presence of comorbidities were associated with higher recurrence risk. Survivors of both first and recurrent AMI remained at a significantly higher risk of death compared with the general population for at least 7 years after the event. For survivors of first AMI, the influence of predisposing factors for second AMI lessened with time after the initial event. The results reinforce the importance of acute clinical care and secondary prevention in improving long-term prognosis of hospitalized AMI patients.

Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study

Objective To report trends in event and case fatality rates for acute myocardial infarction and examine the relative contributions of changes in these rates to changes in total mortality from...

Incidence and 30-day case fatality for acute myocardial infarction in England in 2010: national-linked database study

Background: There are limited national population-based epidemiological data on acute myocardial infarction (AMI) in England, making the current burden of disease, and clinical prognosis, difficult to quantify. The aim of this study was to provide national estimates of incidence and 30-day case fatality rate (CFR) for first and recurrent AMI in England. Methods: Population-based study using person-linked routine hospital and mortality data on 79 896 individuals of any age, who were admitted to hospital for AMI or who died suddenly from AMI in 2010. Results: Of 82 252 AMI events in 2010, 83% were first. Age-standardized incidence of first AMI per 100 000 population was 130 (95% CI 129–131) in men and 55.9 (95% CI 55.3–56.6) in women. Age-standardized 30-day overall CFRs including sudden AMI deaths for men and women, respectively, were 32.4% (95% CI 32.0–32.9) and 30.3% (95% CI 29.8–30.9) for first AMI and 29.7% (95% CI 28.7–30.7) and 26.7% (95% CI 25.5–27.9) for recurrent AMI. Age-standardized hospitalized 30-day CFR was 12.0% (95% CI 11.6–12.3) for men and 12.3% (95% CI 11.9–12.7) for women. Conclusions: While the majority of AMIs are not fatal, of those that are, two-thirds occur as sudden AMI deaths. About one in six of all AMIs are recurrent events. These findings reinforce the importance of primary and secondary prevention in reducing AMI morbidity and mortality.

Improving call-to-balloon times for ST-elevation myocardial infarction

Objectives: The National Infarct Angioplasty Project (NIAP) pilots were set up in 2005 to test the feasibility of implementing a countrywide primary angioplasty (PCI) service for patients with ST-elevated myocardial infarction in England. The authors undertook an evaluation of these pilot sites along with a small number of control sites to assess the workforce and staff implications, patient and carer experience and the cost-effectiveness of primary angioplasty-based care in the real world. Methods: this was a mixed methods study, incorporating four main components: description of models of service delivery, evaluation of workforce and organizational issues, patient and carer evaluation and economic evaluation. Results: pilot sites varied considerably in size and configuration. Many offered ambulance bypass for patients within the catchment for nearby feeder (non-PCI) hospitals or received transfers from these non-PCI hospitals. During the pilot year, 70% (1449/2072) of patients were admitted directly to a PCI site, with a further 21% (435/2072) being transferred from a non-PCI site. Median call-to-balloon times (CTB) were 120 minutes for patients taken directly to a PCI site and 161 minutes for patients who went via a non-PCI site. CTB times can be reduced considerably by improving pathways so that ambulances can bypass non-PCI sites and bypass emergency departments by taking patients directly to the catheter laboratory for assessment. The use of telemetry to enable ECGs to be examined by staff within the coronary care unit can also reduce the number of patients being wrongly transferred to primary angioplasty centres. Time delays that incurred from transferring patients from non-PCI sites to PCI sites indicated that promptly administered thrombolysis may be more cost-effective than PCI in certain circumstances. Patients reported very high levels of satisfaction with care and reported higher levels of satisfaction with speed of treatment and the ambulance journey at NIAP site than control sites. Conclusion: primary PCI was found to be a cost-effective and feasible service, providing CTB times can be minimized by streamlining patient pathways.

Short term effects of temperature on risk of myocardial infarction in England and Wales: time series regression analysis of the Myocardial Ischaemia National Audit Project (MINAP) registry

Objective To examine the short term relation between ambient temperature and risk of myocardial infarction.Design Daily time series regression analysis.Setting 15 conurbations in England and Wales.Participants 84 010 hospital admissions...

Performance indicators in acute myocardial infarction: a proposal for the future assessment of good quality care

Many interventions employed in the management of patients with acute coronary syndromes (ACS) have been proved to be beneficial through well-designed clinical trials. Practice guidelines describe these interventions and the...

Impact of specialty of admitting physician and type of hospital on care and outcome for myocardial infarction in England and Wales during 2004-5: observational study

Impact of specialty of admitting physician and type of hospital on care and outcome for myocardial infarction in England and Wales during 2004-5: observational study

Impact of specialty of admitting physician and type of hospital on care and outcome for myocardial infarction in England and Wales during 2004-5: observational study

Objective To examine process of care and outcome for patients admitted with acute myocardial infarction to hospitals in England and Wales in relation to type of consultant care and type...

Association between the Gene Encoding 5-Lipoxygenase–Activating Protein and Stroke Replicated in a Scottish Population

Cardiovascular diseases, including myocardial infarction (MI) and stroke, most often occur on the background of atherosclerosis, a condition attributed to the interactions between multiple genetic and environmental risk factors. We recently reported a linkage and association study of MI and stroke that yielded a genetic variant, HapA, in the gene encoding 5-lipoxygenase-activating protein (ALOX5AP), that associates with both diseases in Iceland. We also described another ALOX5AP variant, HapB, that associates with MI in England. To further assess the contribution of the ALOX5AP variants to cardiovascular diseases in a population outside Iceland, we genotyped seven single-nucleotide polymorphisms that define both HapA and HapB from 450 patients with ischemic stroke and 710 controls from Aberdeenshire, Scotland. The Icelandic at-risk haplotype, HapA, had significantly greater frequency in Scottish patients than in controls. The carrier frequency in patients and controls was 33.4% and 26.4%, respectively, which resulted in a relative risk of 1.36, under the assumption of a multiplicative model (P=.007). We did not detect association between HapB and ischemic stroke in the Scottish cohort. However, we observed that HapB was overrepresented in male patients. This replication of haplotype association with stroke in a population outside Iceland further supports a role for ALOX5AP in cardiovascular diseases.