Abstract 12582: National Trends in Rehospitalization for Bleeding After Acute Myocardial Infarction in Older Patients, 1999-2010
Background: Older adults with acute myocardial infarction (AMI) are also at high risk for bleeding. It is unclear whether post-discharge bleeding has increased over time with greater use of dual antiplatelet therapy and oral anticoagulants in this population.
Methods: Using Medicare data, we created a cohort of all Fee-for-Service (FFS) patients ≥65 years of age discharged alive following AMI hospitalization from 1999-2010 (N=2,305,441). We calculated bleeding rates within a year after discharge by identifying subsequent hospital admissions with a principal ICD-9 code for bleeding. We used proportional hazards regression to analyze adjusted 1 year readmission for bleeding over time.
Results: Mean age of AMI patients remained stable over time (1999: 78.6 yr, 2010: 78.8 yr), while the proportion of female patients declined (1999: 51.1%, 2010: 48.8%). Some comorbidities were increasingly prevalent, including hypertension (1999: 53.1%; 2010: 66.9%), diabetes (1999: 30.5%; 2010: 32.1%), and renal failure (1999: 4.2%; 2010: 13.5%). There was an 18.6% relative increase in the crude 1-year bleeding rate following AMI over time (1999: 7.9%; 2010: 9.7%, P≤0.01 for trend). There were increases in all subgroups of age, sex, and race, with the highest rates occurring in patients ≥85 years (1999: 8.5%; 2010: 10.1%, P≤0.01 for trend), women (1999: 8.3%; 2010: 10.3%, P≤0.01 for trend) and blacks (1999: 9.9%; 2010: 12.4%, P≤0.01 for trend). After multivariable adjustment, a small but significant increase in the rate of bleeding remained (annual increase HR 1.012, 95% CI 1.010 to 1.013) (Figure).
Conclusions: Readmission for bleeding following AMI has increased significantly over the past 12-years with nearly 1 in 10 elderly AMI patients in 2010 being readmitted for bleeding at one year. The roles of comorbidity and discharge therapy in contributing to this trend need to be further explored.
- © 2013 by American Heart Association, Inc.