Trends In Acute Myocardial Infarction Research Articles

Sex-Specific Trends in Acute Myocardial Infarction Within an Integrated Healthcare Network, 2000 Through 2014

In recent decades, the rates of incident acute myocardial infarction (AMI) have declined in the United States, yet disparities by sex remain. In an integrated healthcare delivery system, we examined temporal trends in incident AMI among women and men. We identified hospitalized AMI among members ≥35 years of age in Kaiser Permanente Southern California. The first hospitalization for AMI overall, and for ST-segment-elevation MI and non-ST-segment-elevation MI was identified by International Classification of Diseases, Ninth Revision, Clinical Modification primary discharge diagnosis codes in each calendar year from 2000 through 2014. Age- and sex-standardized incidence rates per 100 000 person-years were calculated by using direct adjustment to the 2010 US Census population. Average annual percent changes (AAPCs) and period percent changes were calculated, and trend tests were conducted using Poisson regression. We identified 45 331 AMI hospitalizations between 2000 and 2014. Age- and sex-standardized incidence rates of AMI declined from 322.4 (95% CI, 311.0-333.9) in 2000 to 174.6 (95% CI, 168.2-181.0) in 2014, representing an AAPC of -4.4% (95% CI, -4.2 to -4.6) and a period percent change of -46.6%. The AAPC for AMI in women was -4.6% (95% CI, -4.1 to -5.2) between 2000 and 2009 and declined to -2.3% (95% CI, -1.2 to -3.4) between 2010 and 2014. The AAPC for AMI in men was stable over the study period (-4.7% [95% CI, -4.4 to -4.9]). The AAPC for ST-segment-elevation MI hospitalization overall was -8.3% (95% CI, -8.0% to -8.6%).The AAPC in ST-segment-elevation MI changed among women in 2009 (2000-2009: -10.2% [95% CI, -9.3 to -11.1] and in 2010-2014: -5.2% [95% CI, -3.1 to -7.3]) while remaining stable among men (-8.0% [95% CI, -7.6 to -8.4]). The AAPC for non-ST-segment-elevation MI hospitalization was smaller than for ST-segment-elevation MI among both women and men (-1.9% [95% CI, -1.5 to -2.3] and -2.8% [95% CI, -2.5 to -3.2], respectively). These results suggest that the incidence of hospitalized AMI declined between 2000 and 2014; however, declines in AMI have slowed among women in comparison with men in recent years. Determining unmet care needs among women may reduce these sex-based AMI disparities.

Patterns of Acute Myocardial Infarction in Taiwan from 2009 to 2015

Most studies about the trends of acute myocardial infarction (AMI) were based on the data from Western countries. In recent years, little information is available from Asia since 2010. This study assessed the nationwide trends of AMI in Taiwan from 2009 to 2015. Using data from the Taiwan National Health Insurance Research Database, we identified 100,570 adult patients hospitalized for AMI from 2009 to 2015 and examined the temporal trends in the incidence of AMI. Overall, the age- and gender-adjusted incidence of AMI (per 100,000 persons) remained constant from 49.8 in 2009 to 50.7 in 2015. The incidence of AMI increased 30.3% and 29.4% in the young male and female populations (<55 years), whereas in other age groups, the incidence decreased or remained unchanged. The ratio of non-ST-segment elevation MI (NSTEMI) to STEMI incidence increased from 1.93 in 2009 to 2.47 in 2015. In young men (<55 years), a 49.8% increase in NSTEMI was observed. The prevalence of dyslipidemia increased significantly and it was the most common risk factor of AMI in young patients. Despite being increasingly used, percutaneous coronary intervention and secondary preventive medications, including dual antiplatelet therapy, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, β blocker and statin, were less prescribed for NSTEMI compared with STEMI. The in-hospital mortality of STEMI continued to decrease from 2013 to 2015 (8.8% to 7.6%), but not in NSTEMI (13.3% to 13.5%). In conclusion, our study revealed a marked increase of NSTEMI in young Taiwanese male population in recent years. Despite the increased utilization of percutaneous coronary intervention and guideline-recommended medications, the overall in-hospital mortality of NSTEMI remained stagnating in Taiwan.

Cannabis Use Disorder in Young Adults with Acute Myocardial Infarction: Trend Inpatient Study from 2010 to 2014 in the United States.

ObjectiveThis study determines the trend of acute myocardial infarction (AMI) in cannabis users. Demographic characteristics, hospitalization outcomes, and utilization of primary treatment modalities were evaluated in AMI inpatient population.MethodsThe study used data from the nationwide inpatient sample (NIS) for the years 2010-2014. We identified patients with AMI as the primary diagnosis (N = 379,843) and patients with cannabis use disorder as the secondary diagnosis. We used Pearson’s chi-square (χ2) test and independent sample t-test for measuring the categorical and continuous data, respectively.ResultsInpatient admissions for AMI among cannabis users increased by 32% (P = 0.001). The overall mean age of cannabis users with AMI (41 years) remained stable with no significant differences observed across age groups. AMI was predominant in male cannabis users (79.1%), and there was a 38.3% increase in the prevalence in female cannabis users over five years (P < 0.001). About one-third of the cannabis users with AMI were covered by medicaid with a 70.5% pike (21% in 2010 to 37.5% in 2014; P < 0.001). There was a strong linear trend in nonelective admissions for AMI in cannabis users (P = 0.003) along with a moderate-to-severe morbidity (P = 0.001). Mean length of inpatient stay had a decreasing linear trend (P = 0.003), whereas hospitalization costs were increasing (P = 0.024), averaging $65,879 per admission for AMI. Cannabis users had a strong linear increasing trend (P = 0.007), with a 60% increase in in-hospital mortality (1.0% in 2010 to 1.6% in 2014).ConclusionDue to the risk of AMI, as seen in numerous case reports, the trend of emergency admission and severe morbidity due to AMI in cannabis users is also increasing. Also, cannabis users have a higher healthcare cost to manage AMI, yet the in-hospital mortality has risen tremendously over the last few years. It is imperative to know that chronic cannabis worsens the outcomes in AMI patients, and more clinical studies are needed to show the association of episodic use in cannabis abusers and AMI.

TCTAP A-008 Trends of Acute Myocardial Infarction in Korea from the Experience of Korea Acute Myocardial Infarction Registry: What Is Different from Western Registries?

We aimed to assess trends in the characteristics, treatment, and clinical outcomes in patients with AMI including STEMI and NSTEMI, respectively, using the KAMIR data. The study population was derived from patients in the KAMIR enrolled from November 2005 to December 2016. A total of 56,059

Comparison of application of Cochran-Armitage trend test and linear regression analysis for rate trend analysis in epidemiology study

We described the time trend of acute myocardial infarction (AMI) from 1999 to 2013 in Tianjin incidence rate with Cochran-Armitage trend (CAT) test and linear regression analysis, and the results were compared. Based on actual population, CAT test had much stronger statistical power than linear regression analysis for both overall incidence trend and age specific incidence trend (Cochran-Armitage trend P value<linear regression P value). The statistical power of CAT test decreased, while the result of linear regression analysis remained the same when population size was reduced by 100 times and AMI incidence rate remained unchanged. The two statistical methods have their advantages and disadvantages. It is necessary to choose statistical method according the fitting degree of data, or comprehensively analyze the results of two methods.

Acute coronary syndrome-related mortality audit in a teaching hospital at Port Blair, India.

Background:India has a growing trend of acute myocardial infarction (AMI) due to shifting lifestyle.Objective:To study the profile of patients died due to AMI and to find its risk correlates.Methods:A study was conducted on consecutive AMI cases admitted in the teaching hospital at Port Blair from April 2011 to March 2016. During inpatients management, outcomes were followed up from admission till discharge or expiry.Results:Of the total 491 cases, majority (75.99%) had ST-elevated myocardial infarction (STEMI); mean age of 73 deaths was 58.01 ± 13.60, mortality probability among females was less; in the age group 41–50 years the case fatality rate was the lowest (7.58%). Mean age of survival was 56.75 ± 10.47; great majorities were males across all age groups in cases and deaths; highest number of cases were in the age group 51–60 (34.21%); reportedly 83.10% had some physical activities; 6.52% were vegetarian; 34.22% were smokers; 10.39% had family history of AMI, majority (59.06%) were from white collar profession (teacher, clerical, etc.); 52.95% were diabetics; and 47.45% were hypertensives. Lifestyle-related risk factors, physical activity, and vegetarian diet were not protective; family history and addiction to smoking were significantly associated with AMI deaths. Thrombolytic intervention helped the survival of 73.68%, and the odds ratio of survival showed benefit.Conclusions:Acute STEMI had male and middle-age predominance with a common risk factor of family history, smoking, diabetes, and hypertension.

Ethnical disparities in temporal trends of acute myocardial infarction (AMI) throughout a decade in Israel. Soroka acute myocardial infarction (SAMI-II) project.

Ethnical disparities in presentation and outcomes following AMI were reported. We evaluated the temporal-trends of AMI hospitalizations and mortality of Bedouins (Muslims) and Jews in Israel. Retrospective analysis of 15,352 AMI admissions (10,652 patients; 11.3% Bedouins, 88.7% Jews) throughout 2002-2012. The trends in admission rates (AR) were compared using direct age-sex adjustment. The trends of in-hospital mortality (IHM) and 1-year post-discharge mortality (PDM) were adjusted for the patients' characteristics. Bedouins were younger (61.7±14.3 vs. 68.8±13.7years, p<0.001), a higher rate of males. Different prevalence of cardiovascular risk factors was found. STEMI presentation, 3-vessel disease and PCI intervention were more frequently in Bedouins than Jews. Adjusted AR was lower among Jews (4.80/1000 and 3.24/1000 in 2002 and 2012 respectively) than in Bedouins (9.63/1000 and 5.13/1000). A significant decrease of adjusted AR was found in both ethnicities (p-for-trend<0.001 both), greater in Bedouins (p-for-disparity=0.017). The overall rate of IHM was higher for Jews (8.7% vs. 5.6%; p=0.001). The decline of IHM was found in both groups: an increase of one-year resulted in AdjOR=0.877; (p-for-trend<0.001) and 0.910 (p-for-trend=0.052) in Jews and Bedouins respectively (p-for-interaction=0.793). The rates of PDM were higher for Jews (13.6% vs. 9.9%; p=0.001). The risk for PDM increased in both groups: AdjOR=1.118; (p-for-trend<0.001) and 1.093; (p-for-trend=0.012) for one-year increase, for Jews and Bedouins respectively (p-for-interaction=0.927). Throughout 2002-2012 Bedouin AMI patients differed from Jews. Adjusted incidence of AMI declined, greater in Bedouins. IHM declined and PDM increased in both groups. A culturally sensitive prevention program is warranted.

Abstract 5: Trends in Hospitalization Rates and Mortality for Acute Myocardial Infarction by Community Income Level: 1999-2013

Background: Over the last decade, acute myocardial infarction (AMI) incidence and mortality have decreased substantially. Yet it is unknown whether these improvements were consistent across communities of different economic status and geographic regions, for which efforts to improve cardiovascular disease prevention and management may have had variable impact. Objective: To compare trends in risk-standardized AMI hospitalization and 1-year mortality rates from 1999 to 2013 between counties of low, average, and high median income, and to test the effects of income over time and across the 4 U.S. geographic regions. Methods: We performed an observational analysis comparing trends in county-level risk-standardized (age, sex, race) AMI hospitalization and 1-year mortality rates from 1999 to 2013 among Medicare beneficiaries ≥65 years, testing for effects of county-income. Counties were stratified by median income percentile using 1999 U.S. Census Bureau data, adjusted for inflation, as: low (&lt;25th), average (25-75th) or high (&gt;75th) income groups. Using a mixed effects model, we compared trends in AMI hospitalization and mortality rates, stratified by county income. We tested for a lagged effect among low-income counties and compared trends between the 4 U.S. regions. Results: Income was significantly associated with AMI hospitalization, but not 1-year mortality rates. In the 15-year period, AMI risk-standardized hospitalization and mortality rates declined across all three county income groups, though absolute hospitalization rates differed significantly by county income groups (Figure). Low-income county hospitalization rates consistently lagged behind high-income county rates by 4.3 (95%CI: 3.1-5.9) years. There was no difference in rate of decline by geographic region. Conclusion: In this national study of AMI trends from 1999 to 2013, Medicare beneficiaries residing in counties of all income levels achieved substantial declines in AMI hospitalization and mortality. These broad-scale declines may reflect the success of focused AMI prevention efforts or other more secular trends. Nonetheless, disparities persist with low-income counties lagging behind high-income counties - a focus for future national efforts.

Temporal trends in acute myocardial infarction: What about survival of hospital survivors? Disparities between STEMI & NSTEMI remain. Soroka acute myocardial infarction II (SAMI-II) project

BackgroundContemporary data on trends of acute myocardial infarction (AMI), particularly outcomes of hospital survivors by AMI type is sparse. MethodsAnalysis of 11,107 consecutive AMI patients in a tertiary hospital in Israel throughout 2002–2012. The annual incidence of ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI) admissions was calculated using age–gender–ethnicity direct adjustment. A multivariate prognostic model was built to evaluate in-hospital and 1-year post-discharge all-cause-mortality, adjusted for patients' risk factors. ResultsA decline in the adjusted incidence of AMI admissions (per-1000 persons) was documented (2002 vs. 2012) for STEMI: 4.70 vs. 1.38 (p<0.001) and non-significant tendency of increase for NSTEMI: 1.86 vs. 2.37 (p=0.109). The prevalence of most cardiovascular risk-factors, some non-cardiovascular comorbidities and invasive interventions increased. In-hospital mortality declined significantly for STEMI: 10.8% vs. 7.7% (p<0.001) and with no change for NSTEMI: 5.0% vs. 5.5% (p=0.137). Consistently, 1-year post-discharge mortality declined for STEMI: 13% vs. 5.9% (p<0.001) and with a non-significant increase for NSTEMI: 12.6% vs. 17.0% (p=0.377).Adjusting for the risk factors, an increase of one year was associated with a decline of in-hospital mortality for STEMI: AdjOR=0.86 (p<0.001) and for NSTEMI: AdjOR=0.92 (p<0.001). However, the risk for post-discharge mortality increased for STEMI: AdjOR=1.11 (p<0.001) and for NSTEMI: AdjOR=1.12 (p<0.001). ConclusionsThroughout 2002–2012 significant decline in the incidence and of in-hospital mortality of STEMI were found. However, adjusted post-discharge mortality rates increased significantly with time. Measures for improving incidence and outcomes of AMI patients focusing on NSTEMI and hospital-survivors are warranted.

Trends in acute myocardial infarction hospitalizations: Are we seeing the whole picture?

Payers and policy makers rely on studies of trends in acute myocardial infarction (AMI) hospitalizations and spending that count only hospitalizations where the AMI is the principal discharge diagnosis. Hospitalizations with AMI coded as a secondary diagnosis are ignored. The effects of excluding these hospitalizations on estimates of trends are unknown. Observational study of all AMI hospitalizations in Fee-for-Service Medicare beneficiaries 65 years and older, from 2002 through 2011. We studied 3,663,137 hospitalizations with any AMI discharge diagnosis over 288,873,509 beneficiary-years. Of these, 66% had AMI coded as principal (versus secondary). From 2002 to 2011, AMI hospitalization rates declined 24.5% (from 1,485 per 100,000 beneficiary-years in 2002 to 1,122 in 2011). Meanwhile, the proportion of these hospitalizations with a secondary AMI diagnosis increased from 28% to 40%; by 2011 these secondary AMI hospitalizations accounted for 43% of all expenditures for hospitalizations with AMI, or $2.8 billion. Major changes in comorbidities, principal diagnoses and mean costs for hospitalizations with a non-principal AMI diagnosis occurred in the 2006-2008 timeframe. Current estimates of the burden of AMI ignore an increasingly large proportion of overall AMI hospitalizations and spending. Changes in the characteristics of hospitalizations that coincided with major payment and policy changes suggest that non-clinical factors affect AMI coding. Failing to consider all AMIs could inflate estimates of population health improvements, overestimate the value of AMI prevention and treatment and underestimate current and future AMI burden and expenditures.

Effect of the Lookback Period's Length Used to Identify Incident Acute Myocardial Infarction on the Observed Trends on Incidence Rates and Survival: Cardiovascular Disease in Norway Project.

In studies using patient administrative data, the identification of the first (incident) acute myocardial infarction (AMI) in an individual is based on retrospectively excluding previous hospitalizations for the same condition during a fixed time period (lookback period [LP]). Our aim was to investigate whether the length of the LP used to identify the first AMI had an effect on trends in AMI incidence and subsequent survival in a nationwide study. All AMI events during 1994 to 2009 were retrieved from the Cardiovascular Disease in Norway project. Incident AMIs during 2004 to 2009 were identified using LPs of 10, 8, 7, 5, and 3 years. For each LP, we calculated time trends in incident AMI and subsequent 28-day and 1-year mortality rates. Results obtained from analyses using the LP of 10 years were compared with those obtained using shorter LPs. In men, AMI incidence rates declined by 4.2% during 2004 to 2009 (incidence rate ratio, 0.958; 95% confidence interval, 0.935-0.982). The use of other LPs produced similar results, not significantly different from the LP of 10 years. In women, AMI incidence rates declined by 7.3% (incidence rate ratio, 0.927; 95% confidence interval, 0.901-0.955) when an LP of 10 years was used. The decline was statistically significantly smaller for the LP of 5 years (6.2% versus 7.3%; P=0.02) and 3 years (5.9% versus 7.3%; P=0.03). The choice of LP did not influence trends in 28-day and 1-year mortality rates. The length of LP may influence the observed time trends in incident AMIs. This effect is more evident in older women.

Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010: Gupta A, Wang Y, Spertus JA, et al. J Am Coll Cardiol 2014;64:337−45.

Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010: Gupta A, Wang Y, Spertus JA, et al. J Am Coll Cardiol 2014;64:337−45.

Current Trend of Acute Myocardial Infarction in Korea (from the Korea Acute Myocardial Infarction Registry from 2006 to 2013)

Although the incidence of acute myocardial infarction (AMI) in Korea has been rapidly changed because of westernization of diet, lifestyle, and aging of the population, the recent trend of the myocardial infarction have not been reported by classification. We investigated recent trends in the incidence and mortality associated with the 2 major types of AMI. We reviewed 39,978 patients registered in the Korea Acute Myocardial Infarction Registry for either ST-segment elevation acute myocardial infarction (STEMI) or non-ST-segment elevation acute myocardial infarction (NSTEMI) from 2006 to 2013. When the rate for AMI were investigated according to each year, the incidence rates of STEMI decreased markedly from 60.5% in 2006 to 48.1% in 2013 (p <0.001). In contrast, a gradual increase in the incidence rates of NSTEMI was observed from 39.5% in 2006 to 51.9% in 2013 (p <0.001). As risk factors, hypertension, diabetes mellitus, and dyslipidemia were much more common in patients with NSTEMI than STEMI. Among medical treatments, the use of β blockers, angiotensin receptor blocker, and statin were increased from 2006 to 2013 in patients withSTEMI and NSTEMI. Patients with STEMI and NSTEMI were more inclined to be increasingly treated by invasive treatments with percutaneous coronary intervention. In conclusion, this study demonstrated that the trend of myocardial infarction has been changed rapidly in the aspect of risk factors, ratio of STEMI versus NSTEMI, and therapeutic strategies during the recent 8years in Korea.

Trends in hospital performance in acute myocardial infarction care: a retrospective longitudinal study in Japan.

To elucidate the hospital characteristics associated with hospital performance and time trends in acute myocardial infarction (AMI) care using multilevel multivariable analysis of longitudinal data. Retrospective longitudinal study. One hundred and fourteen hospitals in Japan. A total of 26 210 AMI patients admitted between 2008 and 2011. A composite score was calculated from five AMI process measures. Hospital performances and time trends were then investigated based on this composite score. Using generalized linear mixed models with random intercepts (indicating hospital baseline performance) and random slopes (indicating trends in improvement), we analyzed the associations between performance and the following factors: hospital ownership, AMI case volume, number of cardiovascular specialists per AMI patient and participation in a public disclosure program. Hospitals that demonstrated high performance in the composite score were significantly associated with high AMI case volume, municipal ownership and agreement to named disclosure of hospital performance. The following factors were significantly associated with time trends of improvement in performance: public and private ownership, AMI case volume and number of cardiovascular specialists per AMI patient. In addition, higher performances were associated with diminished improvement. Time trends in improvement were related to baseline performance and several hospital characteristics. Furthermore, hospitals that had agreed to named disclosure of performance were more likely to have better quality of care at the initial point of public disclosure. These findings can inform the decision-making process for quality improvement, and allow a greater understanding and interpretation of disclosed performances in quality measures.

Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010

BackgroundVarious national campaigns launched in recent years have focused on young women with acute myocardial infarctions (AMIs). Contemporary longitudinal data about sex differences in clinical characteristics, hospitalization rates, length of stay (LOS), and mortality have not been examined. ObjectivesThis study sought to determine sex differences in clinical characteristics, hospitalization rates, LOS, and in-hospital mortality by age group and race among young patients with AMIs using a large national dataset of U.S. hospital discharges. MethodsUsing the National Inpatient Sample, clinical characteristics, AMI hospitalization rates, LOS, and in-hospital mortality were compared for patients with AMI across ages 30 to 54 years, dividing them into 5-year subgroups from 2001 to 2010, using survey data analysis techniques. ResultsA total of 230,684 hospitalizations were identified with principal discharge diagnoses of AMI in 30- to 54-year-old patients from Nationwide Inpatient Sample data, representing an estimated 1,129,949 hospitalizations in the United States from 2001 to 2010. No statistically significant declines in AMI hospitalization rates were observed in the age groups <55 years or stratified by sex. Prevalence of comorbidities was higher in women and increased among both sexes through the study period. Women had longer LOS and higher in-hospital mortality than men across all age groups. However, observed in-hospital mortality declined significantly for women from 2001 to 2010 (from 3.3% to 2.3%, relative change 30.5%; p for trend < 0.0001) but not for men (from 2% to 1.8%, relative change 8.6%; p for trend = 0.60). ConclusionsAMI hospitalization rates for young people have not declined over the past decade. Young women with AMIs have more comorbidity, longer LOS, and higher in-hospital mortality than young men, although their mortality rates are decreasing.

Abstract 123: A Comparison of In-Hospital Acute Myocardial Infarction Management Between Portugal and the United States: 2000 - 2010

Objectives: Because inter- and intra-country variations in the adoption of medical technologies exist, international comparative studies provide an opportunity to infer technology effectiveness. Few studies have characterized recent trends in acute myocardial infarction (AMI) management between countries. Methods: Repeated cross-sectional observational cohorts of hospitalized adults aged ≥20 years discharged between January 2000 and December 2010. We identified new AMI hospitalizations using a US national 20% inpatient sample and a 100% inpatient sample in all Portuguese public sector hospitals. Age, sex, comorbidities, and median length of stay (interquartile range [IQR]) were determined. Annual age-sex adjusted hospitalization rates (HR) for AMI, in-hospital procedures, and in-hospital mortality were directly standardized to the 2010 US population. Intra-country (2010 relative to 2000) and inter-country in 2010 (Portugal [PT] relative to US) rate ratios [RR] were estimated. Findings: We identified 1476808 AMI US hospitalizations and 126314 Portugal hospitalizations between 2000 and 2010. Portuguese patients were more male, younger, and had fewer comorbidities compared to US patients (Table). The age-sex adjusted AMI HR decreased from 21 per 1000 person-years to 15 in the US (RR=0.70; 95% CI = [0.70, 0.71]) but increased in PT (14 to 15 per 1000, RR = 1.17 [1.14, 1.21]). While crude procedure rates were uniformly lower in PT, only CABG rates differed after standardization (2010: RR=0.19 [0.14, 0.26]). PCI use increased annually in both countries and decreased for CABG in the US only (102 to 79, RR=0.77 [0.73, 0.81]). Standardized in-hospital mortality decreased within-country (US: 44 to 29 per 1000, RR= 0.65 [0.60, 0.72]; PT: 93 to 62 per 1000, RR= 0.67 [0.44, 1.00]). In 2010, PT mortality was twice that in the US. Conclusions: AMI hospitalization rates and use of medical technologies are higher in the US compared to Portugal. However, standardized rates reveal only CABG surgery rates differ significantly between the two countries. Outcomes, measured by hospital mortality and LOS, are generally better in the U.S. Inter-country disparities may be a consequence of differential use of technologies, differences in AMI epidemiology, patient risk, or quality of hospital billing data.

Trends in Acute Myocardial Infarction Event Rates and Risk of Recurrences After an Incident Event in Norway 1994 to 2009 (from a Cardiovascular Disease in Norway Project)

We explored trends in acute myocardial infarction (AMI) event rates in Norway during 1994 to 2009 and trends in the 6-month, 1-year, and 3-year risk of recurrences after an incident AMI during 2001 to 2008 in men and women ≥25 years. Trends in AMI event rates (incident and recurrent) were analyzed using joinpoint regression analyses and expressed as annual percentage change (APC) in rates. Trends in AMI recurrences were explored using conditional risk models for ordered events in Cox regression. Analyses were stratified by gender and age group. Overall, AMI rates were stable during 1994 to 2002 but declined during 2002 to 2009 (APC = -2.0; 95% confidence interval [CI] -3.1 to -0.9 in men; APC = -2.1; 95% CI -3.8 to -0.5 in women). In the younger age group, rates declined during the whole study period in men (APC = -0.6; 95% CI -1.0 to -0.3) but not in women. Among older patients, no changes were observed during 1994 to 2002, whereas rates declined during 2002 to 2009 (APC = -2.6; 95% CI -3.8 to -1.4 in men; APC = -2.4; 95% CI -4.0 to -0.7 in women). During 2001 to 2008, in the older age group, the 6-month, 1-year, and 3-year risks of recurrences were reduced annually by 4.7%, 4.3%, and 5.4% in men and 5.2%, 5.0%, and 5.7% in women (all ptrend <0.001), respectively. No changes were observed in the younger age group. In conclusion, favorable trends in AMI event rates and recurrences observed in Norway were mostly seen among patients aged 65+ years, whereas less favorable trends were observed among younger patients, especially among women.

German nationwide data on current trends and management of acute myocardial infarction: discrepancies between trials and real-life

Recent guidelines on acute myocardial infarction (AMI) are based on randomized clinical trials (RCTs) and registries with selected patients, and may therefore not represent 'real-life'. This analysis shows for the first time nationwide trends in AMI from Germany. We were provided with data on all in-patient hospitalizations by the Federal Statistical Office. All hospitalized cases with AMI (onset of symptoms <28 days) from the years 2005, 2007, and 2009 were analysed regarding morbidity, in-hospital mortality, treatments, and costs. Analysis of a total of 16.1, 16.6, and 17.2 million hospitalizations showed the proportion of coded AMI to remain relatively constant (1276, 1272, and 1181 per 100 000 hospitalizations in 2005, 2007, and 2009). The proportion of ST-elevation AMI decreased over time (STEMI; 631, 546, and 454 per 100 000 hospitalizations),while non-ST-elevation AMI increased (NSTEMI; 645, 726, and 727 per 100 000 hospitalizations). The proportion of older patients >75 years (+4.6%), of comorbidities such as hypertension (+5.8%), diabetes (+17.7%), left ventricular failure (+19.8%), peripheral artery disease (+13.3%), and chronic kidney disease (+165.4%) increased as well. In-hospital mortality remained relatively stable during this period in AMI cases overall (11.1, 10.7, 10.8%) but changed slightly in STEMI (11.2, 11.9, 12.2%) and NSTEMI (11.0, 9.9, 9.9%). Causing about 1.2% of hospitalizations, AMI accounted for 2.5% (1.2 billion €) of in-hospital health expenses. This hospitalization-based analysis revealed a marked increase of NSTEMI among constant AMI frequency. Despite all current efforts, in-hospital mortality was stagnating on a high level compared with data of RCTs.

Most Important Outcomes Research Papers on Cardiovascular Disease in Women

Cardiovascular disease (CVD) in women has been historically understudied. For many years, heart disease had been thought to be primarily a “man’s disease.” Consequently, women have been significantly under-represented in longitudinal studies of disease history and in clinical trials. High-quality data from women at the extremes of age, with multiple co-morbidities, and from racial and ethnic minorities have been particularly rare. In order to increase awareness of cardiovascular prevention among women, in 1999 the American Heart Association (AHA) published its first women-specific clinical recommendations for the prevention of CVD.1 In 2004, the AHA and multiple other collaborating organizations subsequently sponsored “Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women,” which underwent updates in 2007 and 2011. As a result of these and other related initiatives, the rate of public awareness of CVD as the leading cause of death among US women has increased from 30% in 1997 to 54% in 2009.2 CVD-associated death among US women has declined significantly over this time period.3,4 Yet substantial work still needs to be done to improve women’s cardiovascular health. CVD remains the number one killer among women.4 As the obesity epidemic continues, we are actually finding increases in coronary heart disease (CHD) death among young women 35 to 54 years of age.2 Morbidity and mortality from stroke and hypertension remain high.4 In addition, substantial outcomes disparities continue for women from racial and ethnic minorities.4 We have therefore dedicated our topic summaries in this issue of Circulation: Cardiovascular Quality and Outcomes to CVD in women. We have included only those studies where authors provided a convincing a priori reason to study a particular disease process or clinical intervention in women and reported primary endpoints that were sex-specific. We have included articles on the representation of women …

Magnesium intake and cardiovascular disease mortality: A meta-analysis of prospective cohort studies

[1] Roger VL. Myocardial infarction outcomes: “the times, they are a-changing...”. Circ Cardiovasc Qual Outcomes Nov 2010;3(6):568–70. [2] Forman DE, Rich MW, Alexander KP, et al. Cardiac care for older adults. Time for a new paradigm. J Am Coll Cardiol May 3 2011;57(18):1801–10. [3] Movahed M-R, John J, HashemzadehM, Jamal MM, HashemzadehM. Trends in the age adjustedmortality fromacute STsegment elevationmyocardial infarction I theUnited States (1988–2004) based on race, gender, infarct location and comorbidities. Am J Cardiol 2009;104:1030–4. [4] Krumholz HM, Wang Y, Chen J, et al. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995–2006. JAMA 2009;302:767–73. [5] Kostis WJ, Deng Y, Pantazopoulos JS, Moreyra AE, Kostis JB, Myocardial Infarction Data Acquisition System (MIDAS14) Study Group. Trends in mortality of acute myocardial infarction after discharge from the hospital. Circ Cardiovasc Qual Outcomes Nov 2010;3(6):581–9. [6] Gili M, Sala J, Lopez J, et al. Impact of comorbidities on in-hospital mortality from acute myocardial infarction, 2003–2009. [Article in English, Spanish]Rev Esp Cardiol Dec 2011;64(12):1130–7. [7] EuropeanAssociation for Percutaneous Cardiovascular Interventions,WijnsW, KolhP, et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010 Oct;31(20):2501–55. [8] Valente S, Lazzeri C, Vecchio S, et al. Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock. Int J Cardiol 2007;114(2):176–82. [9] Lazzeri C, Sori A, ChiostriM, Gensini GF, Valente S. Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention. Eur J Anaesthesiol 2009;26(10):856–62. [10] Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. Correlates of acute insulin resistance in the early phase of non-diabetic ST-elevation myocardial infarction. Diab Vasc Dis Res Jan 2011;8(1):35–42. [11] Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization. Int J Cardiol 2012;155(1):66–9. [12] Sanchis J, Nunez J, Bodi V, et al. Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation acute coronary syndrome. Mayo Clin Proc Apr 2011;86(4):291–6. [13] Masoudi FA, Foody JM, Havranek EP, et al. Trends in acute myocardial infarction in 4 US states between 1992 and 2001: clinical characteristics, quality of care, and outcomes. Circulation 2006;114:2806–14. [14] Setoguchi S, Glynn RJ, Avorn J, Mittleman MA, Levin R, Windelmayer WC. Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis. J Am Coll Cardiol 2008;51:1247–54.