Abstract 9112: Trends in Mortality of Acute Myocardial Infarction After Discharge From the Hospital
Introduction: We assessed trends in the prognosis of patients with acute myocardial infarction (AMI) who were discharged alive from New Jersey hospitals. In the last decades, in-hospital mortality has declined markedly but the decline in longer-term mortality is less pronounced implying that mortality after discharge has worsened. At the same time, the demographics, co-morbidities, diagnosis and management of AMI have changed.
Methods: We used the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database, to examine the outcome of 285,397 patients with a first AMI between 1986 and 2007.
Results: Mortality at discharge decreased by 9.4% from 16.9% to 7.5%, but the decrease at 1 year was less pronounced (6.4%) due to an increase in mortality from discharge to 1 year post-discharge (from 12.1% to 13.9%, 1.8% increase). Also, mortality from 30 days post-discharge to 1 year, a measure not affected by length of stay, increased by 1.2%. The effect was more evident in the older age groups and was due to higher non-cardiovascular mortality, especially from diabetes, respiratory and renal diseases, and cancer. All effects p<0.0001 after adjustment for demographics, co-morbidities, infarction type, complications, and interventions. Figure: % change in lives gained and lost for each year compared to 1986. Dark Green=lower in-hospital mortality; Light Green=lower mortality between discharge and 1-year post-discharge; Red=higher mortality between discharge and 1-year post-discharge; left upper: all patients, cardiovascular death; right upper: all patients, non-cardiovascular death; left lower: age 35–60, all death; right lower: age 81+, all death.
Conclusions: Post-discharge mortality of AMI patients is increasing, primarily because of higher non-cardiovascular mortality in the older age groups. Attention to co-morbidities and preventive strategies for diabetes, respiratory and renal disease, and cancer may result in better long-term outcomes.
- © 2010 by American Heart Association, Inc.