National Trends in Heart Failure Hospitalization after Acute Myocardial Infarction for Medicare Beneficiaries: 1998-2010
Background—Previous studies have reported conflicting findings regarding how the incidence of heart failure (HF) following acute myocardial infarction (AMI) has changed over time, and data on contemporary national trends are sparse.
Methods and Results—Using a complete national sample of 2,789,943 AMI hospitalizations of Medicare fee-for-service beneficiaries from 1998-2010, we evaluated annual changes in the incidence of subsequent HF hospitalization and mortality using Poisson and survival analysis models. The number of patients hospitalized for HF within 1 year following AMI declined modestly from 16.1 per 100 person-years in 1998 to 14.2 per 100 person years in 2010 (p<0.001). After adjusting for demographic factors, a relative 14.6% decline for HF hospitalizations after AMI was observed over the study period (incidence risk ratio 0.854, 95% confidence interval [CI] 0.809-0.901). Unadjusted 1-year mortality following HF hospitalization after AMI was 44.4% in 1998, which decreased to 43.2% in 2004-2005, but then increased to 45.5% by 2010. After adjusting for demographic factors and clinical comorbidities, this represented a 2.4% relative annual decline (hazard ratio [HR] 0.976, 95% CI 0.974-0.978) from 1998 to 2007, but a 5.1% relative annual increase from 2007 to 2010 (HR 1.051, 95% CI 1.039-1.064).
Conclusions—In a national sample of Medicare beneficiaries, HF hospitalization following AMI decreased from 1998 to 2010, which may indicate improvements in the management of AMI. In contrast, survival after HF following AMI remains poor, and has worsened from 2007 to 2010, demonstrating that challenges still remain for the treatment of this high-risk condition after AMI.
- Received May 8, 2013.
- Revision received September 25, 2013.
- Accepted October 3, 2013.