Abstract 21079: 20 Year Trends (1988-2008) for AMI and Cardiovascular Procedures in California Hospitals
Over the past two decades from 1998 to 2008, risk factors for coronary artery disease such as the rates of obesity and diabetes have increased. During the same period, successful smoking cessation programs, widespread use of cholesterol-lowering drugs and promotion of heart-healthy diets and exercise have aimed at preventing CAD. We hypothesized that to date, the summed effect of these competing risk factors decreased the incidence of acute myocardial infarction (AMI) as well as selected cardiovascular procedures. We used the California hospital patient discharge data that were analyzed for even-numbered years, 1988-2008, using ICD-9 codes to identify the frequency of AMI, percutaneous coronary intervention (PCI), and coronary artery bypass graft surgery (CABG). Population rates (per 1,000 for AMI and per 10,000 for CABG and PCI) were calculated using the California Department of Finance population data. We found that from 1988 to 2008, California's total population increased 35%. The total volume of AMI hospitalizations increased 15% (from 59,655 to 68,424 annually), but the AMI rate decreased 15%. The decrease was observed exclusively among whites, but not other ethnic groups, and across all age groups except ages 90+ years. For PCI, the total annual volume of PCI rose 145% (from 24,255 to 59,509). The PCI rate peaked in 2004 at 16.3 then fell by 16.5% to 13.6 in 2008. After 2004, the PCI rate fell in all ages (as much as 25% for ages 60-69) but primarily in white and Hispanic populations. The total annual volume of CABG decreased by 25% (from 23,604 to 17,705). The rate peaked in 1996 at 10.1 then fell by 54% to 4.6 in 2008. After 1996, the rate decreased in all ages (as much as 67% for ages 50-59) and all ethnicities. The rate for whites remained 2 - 3 times higher and showed the largest decrease compared to all ethnicities. We concluded that from 1988 to 2008, the hospitalization rate for AMI declined, but only partly accounted for declining use of CABG and PCI. There has been no stabilization in the decreasing rates of PCI and CABG. Changes in procedure volume and changes in AMI demographics continue to exert a significant impact on healthcare costs, human resources, facilities requirements and cardiovascular training programs.
- Coronary artery disease
- Myocardial infarction
- Percutaneous coronary intervention
- Aortocoronary bypass
- © 2010 by American Heart Association, Inc.