One year of Covid-19: French nationwide study of hospitalisation, 90-day readmission and mortality rates from myocardial infarction

Background: Elderly survivors of acute myocardial infarction (AMI) are at elevated risk for hemorrhagic stroke, which has a mortality rate of approximately 50%. Increasing use of warfarin for arterial fibrillation and anti-platelet agents for AMI combined with an increasing aging population may have influenced the risk of post-AMI strokes. We sought to characterize temporal trends in the risk for and mortality from hemorrhagic stroke over 12 years among older AMI survivors of different age, sex, race, revascularization status, and region within the US. Methods: We used 100% of Medicare inpatient claims data to identify all fee-for-service (FFS) patients aged> 64 years who were hospitalized for AMI in 1999-2010. We excluded patients who died during the hospitalization or were transferred. Revascularization procedures were identified during the index admission. We used a Cox proportional-hazards regression model to estimate the risk-adjusted annual changes in one-year hemorrhagic stroke hospitalization after AMI, overall and by subgroups. Changes were adjusted by age, gender, race, medical history and comorbidities. We calculated the 30-day mortality among patients readmitted for hemorrhagic stroke. Stroke belt regions were defined as the states with high stroke hospitalization rates in the southeast United States. Results: Among 2,433,036 AMI hospitalizations and 4,852 hemorrhagic stroke readmissions, the risk-adjusted one-year post-AMI hemorrhagic stroke rate remained stable from 1999 to 2010 (range, 0.2% to 0.3%). No significant trends were found for post-AMI stroke rates across all age-sex-race groups and all treatment groups (Figure). Thirty-day mortality rates for stroke after AMI did not show significant changes (1999, 46.7%, 95% CI 39.9%-53.7%; 2010, 50.7%, 95% CI 45.3%-56.1%; range: 46.5% to 54.6%). No difference was found in post-AMI hemorrhagic stroke rates between the stroke belt and non-stroke belt regions. Conclusions: From 1999 to 2010, the overall hospitalization rates of hemorrhagic stroke after AMI were relatively stable without significant changes across all subgroups. Thirty-day mortality rates remained largely unchanged over time. Stroke risk in the stroke belt was not found significantly higher comparing with non-stroke belt states.

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Prevalent Prediabetes at Admission due to Acute Myocardial Infarction Does Not Affect One-Year Mortality Rates of Patients Who Were Discharged Alive

Diabetes ◽

10.2337/db18-432-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 432-P

Author(s):

IE BYUNG PARK ◽

DAE HO LEE ◽

SEUNG HEE YU ◽

KIYOUNG LEE

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mortality Rates ◽

One Year

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Abstract 330: Hospital-Level Variation in One-Year Mortality and Angina Following Myocardial Infarction is Not Explained by In-Hospital Quality of Care in the TRIUMPH Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a330 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Rebecca Vigen ◽

P M Ho ◽

Philip G Jones ◽

John A Spertus ◽

Suzanne V Arnold ◽

...

Keyword(s):

Myocardial Infarction ◽

Quality Of Care ◽

Health Status ◽

Mortality Rates ◽

Hospital Quality ◽

Level Variation ◽

Hospital Level ◽

Longitudinal Outcomes ◽

One Year

Background: Studies demonstrating variation in hospital quality of care using longitudinal outcomes have been limited in the amount of clinical data used to stratify patients’ risks and have not examined health status outcomes. We sought to describe hospital-level variation in risk-adjusted health status and mortality in the year following myocardial infarction (MI) and describe the extent to which hospital quality of care explains this variation. Methods: 4,316 patients from the TRIUMPH registry, a prospective cohort study of MI patients at 24 hospitals, were included for analysis. Using hierarchical models, we described the hospital-level variation in angina (yes/no) and 1-year mortality rates. We then added hospital quality of care measures for MI applicable to the time period studied (ASA and beta blockers within 24 hours of arrival and at discharge, ACE/ARB at discharge, thrombolytics within 30 minutes, PCI within 90 minutes, and smoking cessation instructions at discharge) to these models to determine if hospital variation in one-year mortality and angina were explained by index MI quality of care. Results: The mortality rate at one year was 6.2% and the incidence of angina at one year was 23.0%. Unadjusted hospital-level 1-year mortality ranged from 0% to 10.8% and unadjusted presence of angina ranged from 9.3% to 66.7%. Statistically significant hospital-level variation in one-year mortality and angina was observed, with risk-adjusted mortality rates ranging from 5% to 8.3% (p<0.0001) and risk-adjusted angina rates ranging from 17.6% to 31.9% (p<0.0001). In-hospital quality of care measures did not attenuate hospital-level variation in mortality or angina (Figure 1). Conclusions: Hospital-level variation in 1-year mortality and angina was observed among the 24 hospitals participating in this MI registry. However, this variation was not explained by in-hospital MI performance measures. Future studies should assess care delivery factors that impact longitudinal outcomes following MI.

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Abstract 4013: The Impact of Atrial Fibrillation on the outcomes of patients suffering a second Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_818-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Yingzi Deng ◽

William J Kostis ◽

Alan C Wilson ◽

Nora Cosgrove ◽

Yu-Hsuan Shao ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Hospital Admissions ◽

Strong Predictor ◽

Mortality Rates ◽

Percutaneous Coronary ◽

History Of ◽

Short And Long Term ◽

One Year ◽

The Impact

In the past 20 years, significant increases in hospital admissions for atrial fibrillation (AF) and in survival of acute myocardial infarction (MI) have been observed. We examined the occurrence of AF and its effect on short and long term outcomes of first MI(FMI) and second MI(SMI). Hospitalized MIs from MIDAS (Myocardial Infarction Data Acquisition System, N=269,110) in New Jersey from 1986 to 2005 were included in the analysis. The rate of the co-exiting MI and AF and 30-day and 1 year mortality were investigated. Approximately 11 %( N=26,631) of FMI patients had a second event. The rate of co-existing AF for the FMI was 9.6% in 1986 and 16.2% in 2005, a 40.9% increase; while AF increased 60.4%, from 7.7% to 20.5% for SMI. Patients with AF were older (76.5 vs 69.3), more likely to be female (43.6% vs 39.4%), to have subendocardial infarction (58.5% vs 49.2%). Patients AF were less likely to be black in racial (4.2% vs 8.4%) and to receive percutaneous coronary interventions (PCI) (6.1% vs 10.4 %). There were more strokes (2% vs 0.9%) and heart failure hospitalizations (HF, 58% vs 39%) in the AF group(p<0.0001). Thirty-day mortality rates (AF vs non-AF) were 20.9% and 13.8% for the FMIs; and 21.5% vs 14.2% for SMIs. One-year mortality rates were 37.4% and 20.5% at FMI, and 43.3% and 28.1% at the SMI, respectively. When adjusting for age, gender, race, MI site, PCI, year of MI, diabetes, stroke and HF, AF increased the 30 day mortality by 36%( OR1.36 95% CI 1.32–1.41) for FMI, and by 33% (OR 1.33(1.22–1.46)] for SMI. The effect of AF on mortality was more pronounced at 1 year [FMI 1.54(1.50 –1.58), SMI:1.44(1.34 –1.55)]. Current AF as well as the history of AF increased both 30-day [OR for current AF: 1.35(1.22–1.50), history of AF: 1.17(1.04 –1.32)] and 1-year mortality [current AF: 1.5(1.4 –1.6), history of AF: 1.21(1.11–1.33)]. The rate of AF in MI patients has increased, especially SMIs. AF remains as a strong predictor of worse outcome for patients suffering a second MI. Both the history of AF and current AF were associated with higher mortality in MI patients.

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Higher incidence of morbidity in women than men with non-functioning pituitary adenoma: a Swedish nationwide study

Acta Endocrinologica ◽

10.1530/eje-16-0173 ◽

2016 ◽

Vol 175 (1) ◽

pp. 55-61 ◽

Cited By ~ 18

Author(s):

Daniel S Olsson ◽

Ing-Liss Bryngelsson ◽

Oskar Ragnarsson

Keyword(s):

Myocardial Infarction ◽

General Population ◽

Cerebral Infarction ◽

Mortality Rates ◽

Population Based ◽

Population Based Study ◽

Nationwide Study ◽

Gender Influences ◽

Non Functioning Pituitary Adenomas

Objective Increased mortality rates are found in women and young adults with non-functioning pituitary adenomas (NFPAs). This nationwide study aimed to investigate the burden of comorbidities in patients with NFPA and to examine whether gender influences the outcome. Design NFPA patients were identified and followed-up from National Registries in Sweden. It was a nationwide, population-based study. Method Standardised incidence ratios (SIRs) for comorbidities with 95% confidence intervals (CI). Comorbidities were analysed in all patients, both patients with and without hypopituitarism. Results Included in the analysis were 2795 patients (1502 men, 1293 women), diagnosed with NFPA between 1987 and 2011. Hypopituitarism was reported in 1500 patients (54%). Mean patient-years at risk per patient was 7 (range 0–25). Both men (SIR 2.2, 95% CI: 1.8–2.5; P<0.001) and women (2.9, 2.4–3.6; P<0.001) had a higher incidence of type 2 diabetes mellitus (T2DM) than the general population, with women having a higher incidence compared with men (P=0.02). The incidence of myocardial infarction was increased in women (1.7, 1.3–2.1; P<0.001), but not in men. Both men (1.3, 1.1–1.6; P=0.006) and women (2.3; 1.9–2.8; P<0.001) had an increased incidence of cerebral infarction, with women having a higher incidence than men (P<0.001). The incidence of sepsis was increased for both genders. The incidence of fractures was increased in women (1.8, 1.5–1.8; P<0.001), but not for men. Conclusions This nationwide study shows excessive morbidity due to T2DM, cerebral infarction and sepsis in all NFPA patients. Women had higher incidence of T2DM, myocardial infarction, cerebral infarction and fracture in comparison to both the general population and to men.

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Abstract P244: Do Interventions in Acute Myocardial Infarction Improve Outcome Past 30 Days?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap244 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Robert Bryg ◽

David J Bryg

Keyword(s):

Myocardial Infarction ◽

Meta Analysis ◽

Mortality Rates ◽

The Past ◽

Mortality Hazard ◽

Hazard Ratios ◽

Acute Mi ◽

One Year ◽

Improvement In Survival ◽

Mortality Hazard Ratio

Survival after myocardial infarction (MI) has improved dramatically since the advent of thrombolytic therapy. Multiple therapies have been evaluated in the past 3 decades to attempt to improve both short and long term survival in patients suffering an acute MI. There is, however, little information on how survival from 1 month to 1 year after MI has changed since the advent of thrombolytic therapy. To answer this question, we searched for randomized clinical trials of acute MI that provided both 30 day and 1 year mortality rates. Utilizing a competing risk model, we calculated both the 1 year and the landmarked 30 day to 1 year mortality hazard ratios in each of the clinical trials. These mortality hazard ratios are in comparison to published US Life Tables and are normalized for age, gender and length of follow up. We then compared these mortality rates in each of the past 3 decades for both the one year and the landmark 30 day to 1 year timeframes. We performed meta-analysis on these interventions to determine if the change in 30 day to 1 year mortality is due to the interventions examined in these studies. There has been a marked improvement in survival with a 63% reduction in both 1 year, and 30 day to 1 year mortality. Meta analysis demonstrated that there has been no additional survival benefit seen after 30 days with the interventions evaluated: principally thrombolysis and antithrombotic therapies. Despite the dramatic improvement in mortality over time, the interventions in these trials do not appear to contribute to this improvement. Despite the lack of benefit after 30 days with acute thrombolysis, angioplasty and antithrombotic agents, profound improvement in survival has occurred. It is probable that other post MI interventions commonly utilized, including aspirin, beta blocker therapy, invasive strategies, and smoking cessation, are contributing to this marked reduction in post MI mortality. Results One Year Mortality Hazard Ratio Landmark 30 Day to 1 Year Mortality Hazard Ratio Year # of Studies Control Treatment Control Treatment 1980-89 4 9.779 8.541 4.753 4.546 1990-99 7 5.052 4.808 2.353 2.217 2000-09 20 3.420 3.404 1.662 1.789

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