P2653Seasonal variations of myocardial infarction and sex-specific differences in Germany

Abstract Background Ischemic heart disease (IHD) is the most common cause of death with an increasing frequency worldwide. It accounts for approximately 20% of all deaths in Europe and the United States of America. Approximately 1/3 of the IHD patients present with sudden cardiac death. The acute presentation of IHD myocardial infarction (MI) is a life-threatening, serious health problem, which causes substantially morbidity and mortality. It is well established that the onset of MI follows a circadian and seasonal periodicity. Seasonal variation regarding the incidence and the short-term mortality of acute MI was frequently reported, but data about sex-specific differences are sparse. Purpose Thus, our objectives were to investigate seasonal variations of myocardial infarction. Methods We analyzed the impact of seasons on incidence and in-hospital mortality of patients with acute MI in Germany from 2005 to 2015. We included all MI patients (ICD code I21) with an acute MI (, but not those MI patients with a recurrent event in the first 28 days after a previous MI (ICD code I22)), who were hospitalized in Germany between 2005 and 2015, in this analysis (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2015, own calculations). Results The nationwide sample comprised 3,008,188 hospitalizations of patients with MI (2005–2015). The annual incidence was 334.7 per 100.000 population. Incidence inclined from 316.3 to 341.6 per 100.000 population per year (β 0.17 [0.10 to 0.24], P<0.001), while in-hospital mortality rate decreased from 14.1% to 11.3% (β −0.29 [−0.30 to −0.28, P<0.001). Overall, 377,028 (12.5%) patients died in-hospital. Seasonal variation of both incidence and in-hospital mortality were of substantial magnitude. Seasonal incidence (86.1 vs. 79.0 per 100.000 population per year, P<0.001) and in-hospital mortality (13.2% vs. 12.1%, P<0.001) were higher in the winter than in the summer saeson. Risk to die in winter was elevated (OR 1.080 (95% CI 1.069–1.091), P<0.001) compared to summer season independently of sex, age and comorbidities. Reperfusion treatment with drug eluting stents and coronary artery bypass graft were more often used in summer. We observed sex-specific differences regarding the seasonal variation of in-hospital mortality: males showed lowest mortality in summer, while females during fall. Low temperature dependency of mortality seems more pronounced in males. Conclusions Incidence of acute MI increased 2005–2015, while in-hospital mortality rate decreased. Seasonal variations of incidence and in-hospital mortality were of substantial magnitude with lowest incidence and lowest mortality in the summer season. Additionally, we observed sex-specific differences regarding the seasonal variation of the in-hospital mortality. Acknowledgement/Funding This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503)

Download Full-text

Abstract 257: Urban Teaching and Non-Teaching Hospitals Outcomes: Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.257 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Priscilla O Okunji ◽

Johnnie Daniel

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Income Group ◽

The United States ◽

Teaching Hospitals ◽

Age Difference ◽

Age Group ◽

Urban Teaching ◽

Significant Difference ◽

The Impact

Background: Patients with myocardial infarction reportedly have different outcomes on discharge according to hospital characteristics. In the present study, we evaluated the differences between urban teaching hospitals (UTH) and non-teaching hospitals (NTH), discharged in 2012. We also investigated on the outcomes. Methods: Sample of 117,808 subjects diagnosed with myocardial infarction were extracted from a nationwide inpatient stay dataset using the International Classification Data, ICD 9 code 41000 in the United States, according to hospital location, size, and teaching status. Results: The analysis of the data showed that more whites were admitted to both teaching and non teaching hospitals with more males (~24%) admitted than their female counterparts. However, blacks were admitted more (~15%) in urban teaching hospitals than medium urban non teaching hospitals. Age difference was noted as well, while age group (60-79 years) were admitted more in UTH, inversely urban non-teaching hospitals admitted more older (80 years or older) age group. A significant difference (~28%) was observed in both hospital categories with UTH admitting more patients of $1.00 - $38,999.00 income group than other income categories. In addition, it was observed that patients with MI stayed more (~5%) for 14 or more days, and charged more especially for income group of $80,000 or above in UTH than NTH. No significant difference was found in the mortality rate for both hospital categories. Conclusion: The overall outcomes showed that the mortality rate between urban teaching and non-teaching hospitals were non significant, though the inpatients MI stayed longer and were charged more in UTH than NTH. The authors call for the study to be replicated with a higher level of statistical measures to ascertain the impact of the variables on the outcomes for a more validated result.

Download Full-text

Abstract 248: Mortality and Readmission After Acute Myocardial Infarction in the Department of Veterans Affairs Health Care System

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.248 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Paul L Hess ◽

Elise C Gunzburger ◽

Chuan-Fen Liu ◽

Jacqueline Jones ◽

Daniel D Matlock ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Veterans Affairs ◽

Unplanned Readmission ◽

Level Variation ◽

Readmission Rates ◽

Acute Mi ◽

Over Time

Background: Little contemporary data about the performance of Veterans Affairs (VA) hospitals related to mortality and readmission rates after an acute myocardial infarction (MI) are available. Accordingly, we sought to characterize the rates of in-hospital and 30-day mortality and 30-day unplanned readmission after an acute MI as well as associated site-level variation. Methods: Using data from the External Peer Review Program, which abstracts data from the records of all patients admitted with an acute MI, linked with administrative data from the Corporate Data Warehouse, we performed an observational analysis of patients admitted with an acute MI from January 1, 2011, to February 28, 2014. Results: A total of 16,024 patients were admitted with an acute MI; 806 (5.0%) patients died during hospitalization, 1299 (8.1%) died within 30 days of admission, and 2529 (16.9%) had an unplanned hospital readmission. The annual risk-standardized in-hospital mortality rate (Hazard Ratio (HR) 0.90, 95% Credible Interval (CI) 0.83-0.98) and the 30-day mortality rate (HR 0.94, 95% CI 0.88-1.00) but not the unplanned readmission rate (HR 1.00, 95% CI 0.96-1.04) decreased over time ( Figure ). Individual hospital rates for in-hospital mortality, 30-day mortality, and 30-day unplanned readmission were comparable to the system-wide rates, with little variation between hospitals. Conclusions: In Veterans Affairs hospitals from 2011 to 2014, in-hospital and 30-day mortality but not 30-day unplanned readmissions rates declined over time. Little site-level variation in mortality or readmission rates was observed.

Download Full-text

The impact of low diastolic blood pressure on 30-day mortality of patients with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1652 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Asano ◽

Y Mitsuhashi ◽

M Sachi ◽

K Wakabayashi ◽

K Yahagi ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Acute Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Diastolic Blood Pressure ◽

Multivariate Logistic Regression Analysis ◽

Term Outcome ◽

Time Of Admission ◽

The Impact

Abstract Background It is known that low diastolic blood pressure (DBP) is associated with long-term cardiovascular events after acute myocardial infarction (AMI). However, the impact of low diastolic blood pressure on short-term outcome has not yet been well investigated. Methods and results We included 15,208 patients who were hospitalized for AMI and registered in the Tokyo CCU network registry between 2013 and 2016. Thirty-day in-hospital mortality rate was 4.8% (728/15,208). To assess the relationship between DBP at the time of admission and 30-day mortality non-linearly, spline regression model was applied with the stratification of the cohort according to tercile of systolic blood pressure (SBP, low:≤122 mmHg, intermediate:123–148 mmHg, high:≥149 mmHg) and J-curve phenomenon was observed in the low and high SBP groups. In multivariate logistic regression analysis, adjusted odds ratio of the lowest quintile of DBP (≤64 mmHg) was 1.65 (95% CI:1.02–2.66) in low SBP group and 4.55 (95% CI:1.72–12.00) in high SBP group. Conclusion Low DBP was associated with increased 30-day in-hospital mortality rate after AMI even in patients with high SBP. Funding Acknowledgement Type of funding source: None

Download Full-text

Influenza vaccination and in-hospital mortality in patients with acute myocardial infarction with history of prior PCI or CABG: a nationwide cohort analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1496 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S.P Patil ◽

K Gonuguntla ◽

C Rojulpote ◽

A.J Borja ◽

V Zhang ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Influenza Vaccination ◽

Lower Risk ◽

Bypass Graft ◽

The United States ◽

Risk Of Death ◽

History Of ◽

The Impact

Abstract Introduction Influenza vaccination is associated with lower risk of death as well as major adverse cardiovascular events, including acute myocardial infarction (AMI), heart failure and stroke. Purpose The impact of Influenza vaccination on in-hospital mortality in patients with AMI with a prior history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) is largely unknown. We hypothesize that such individuals who develop AMI have better outcomes if they had received influenza vaccine. Methods We analyzed the United States National Inpatient Sample Database from 2010–2014 to identify patients with primary discharge diagnosis of AMI (STEMI, NSTEMI) with a history of prior PCI or CABG. In this cohort, patients with influenza vaccination were identified using ICD-9 code V04.81. The primary outcome was in-hospital mortality. Chi-square test and multivariate regression model controlling for age, gender, race, type of AMI and co-morbidities were employed for statistical analysis. Results A total of 495,619 patients with ACS were identified who had prior PCI or CABG and 6525 had positive influenza vaccination status. Influenza vaccination was independently associated with lower risk of in-hospital mortality in patients with AMI (aOR = 0.253, 95% CI: 0.196–0.328; p<0.001). Conclusion Vaccination against influenza was associated with lower risk of in-hospital mortality in patients with prior PCI or CABG who developed AMI. Figure 1 Funding Acknowledgement Type of funding source: None

Download Full-text

P5520Evaluation of the impact of the implementation of a pre-hospital ambulance system on acute myocardial infarction mortality in a developing country

European Heart Journal ◽

10.1093/eurheartj/ehz746.0468 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R C P Vieira ◽

M S Marcolino ◽

L G Silva-E-Silva ◽

A O Jorge ◽

A L Ribeiro

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Seasonal Variation ◽

Hospital Mortality ◽

Prehospital Care ◽

Mortality Rates ◽

Minas Gerais ◽

The State ◽

Main Role ◽

The Impact

Abstract Background Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. The effective management of patients with AMI is directly linked to time, and approximately one-half of the deaths attributed to AMI occur from cardiac arrest in the out-of-hospital setting, reinforcing the importance of the prehospital care. Contemporary data remain particularly lacking about the use of prehospital care in the setting of AMI, particularly from the more generalizable perspective of a community-based investigation, as well as information about the hospital outcomes of patients transported by ambulance. Purpose To assess the impact the implementation of a nationwide ambulance service (Serviço de Atendimento Médico de Urgência, SAMU) on AMI mortality and number of hospitalizations, in the state of Minas Gerais, Brazil. Methods Retrospective, ecological study, which assessed data from the Brazilian Universal Health System (SUS), from all 853 municipalities of Minas Gerais, from 2008 to 2016. SAMU implementation dates were obtained from the state government and SAMU local coordinators. Data on the population of each municipality was obtained from Instituto Brasileiro de Geografia e Estatística (IBGE), the Brazilian official demographic institute. Excessive skewness of general and in-hospital mortality rates were smoothed using the Empirical Bayes method The relationship between SAMU care in each municipality and the mortality due to AMI in the general population, in-hospital mortality and number of hospitalizations for AMI was assessed using the Poisson hierarchical model, and the analyzed rates were corrected by the age structure and detrended by seasonal influences. Results AMI mortality rates showed a decreasing tendency throughout the study, on average 2% per year, and seasonal variation, being higher during winter months. Age-corrected AMI in-hospital mortality also showed a decreasing trend, from 13.81% in 2008 to 11.43% in 2016. SAMU implementation was associated with decreased AMI mortality (odds ratio [OR]=0.967, 95% confidence interval [CI] 0.936–0.998) and AMI in-hospital mortality (OR=0.914, 95% CI 0.845–0.986) with no relation with the number of hospitalizations (OR 1.003, 95% CI 0.927–1.083). There was no seasonal variation in the number of AMI hospitalizations. Conclusion SAMU implementation was related to a modest but significant decrease in AMI in-hospital mortality. This finding reinforces the main role of prehospital care in AMI care and reinforces the need for investment in improving the service throughout the country.

Download Full-text

Sex-specific and age-related seasonal variations regarding incidence and in-hospital mortality of pulmonary embolism in Germany

ERJ Open Research ◽

10.1183/23120541.00181-2020 ◽

2020 ◽

Vol 6 (2) ◽

pp. 00181-2020

Author(s):

Karsten Keller ◽

Lukas Hobohm ◽

Thomas Münzel ◽

Stavros V. Konstantinides ◽

Mareike Lankeit

Keyword(s):

Pulmonary Embolism ◽

Seasonal Variation ◽

Hospital Mortality ◽

Seasonal Variations ◽

Nationwide Inpatient Sample ◽

Age Related ◽

Significant Seasonal Variation ◽

Incidence And Mortality ◽

Short Term Mortality ◽

The Impact

BackgroundStudies have reported seasonal variations regarding the incidence and the short-term mortality of pulmonary embolism (PE). The aim of this study was to identify sex-specific and age-related differences in seasonal patterns regarding hospitalisations and mortality of PE patients.MethodsWe analysed the impact of seasons on incidence and in-hospital mortality of male and female hospitalised PE patients in Germany (2005–2015) based on the German nationwide inpatient sample.ResultsThe German nationwide inpatient sample comprised 885 806 hospitalisations due to PE (2005–2015). Seasonal variations of both incidence (p=0.021) and in-hospital mortality (p<0.001) were of significant magnitude. Quarterly annual incidence (25.5 versus 23.7 of 100 000 citizens per year, p=0.021) and in-hospital mortality (17.0% versus 16.7%, p=0.008) were higher in winter than in summer. Risk of in-hospital mortality in winter was slightly higher (OR 1.03 (95% CI 1.01–1.06), p=0.015) compared to summer, independently of sex, age and comorbidities. Additionally, we observed sex-specific differences during seasons: the highest number of hospitalisations of PE patients of both sexes was during winter, whereas the nadir of male patients was in spring and that of female patients was in summer. Both sexes showed a maximum of in-hospital mortality in spring. Seasonal variation regarding incidence and mortality was pronounced in older patients.ConclusionIncidence and the in-hospital mortality of PE patients showed a significant seasonal variation with sex-specific differences. Although it has to be hypothesised that the seasonal variation of PE is multifactorially dependent, variation in each season was not explained by seasonal differences regarding age, sex and the prevalence of important comorbidities.

Download Full-text

Trends and seasonal variation of hospitalization and mortality of interstitial lung disease in the United States from 2006 to 2016

10.21203/rs.3.rs-18341/v1 ◽

2020 ◽

Author(s):

An Ho ◽

Artem Shmelev ◽

Edward Charbek

Keyword(s):

Seasonal Variation ◽

Interstitial Lung Disease ◽

Mortality Rate ◽

Hospital Mortality ◽

Hospital Admission ◽

Lung Disease ◽

Seasonal Variations ◽

Hospital Admissions ◽

Mortality Rates ◽

Admission Rates

Abstract BackgroundIn the recent years, the overall trends in hospital admission and mortality of interstitial lung disease (ILD) are unknown. In addition, there was some evidence that interstitial lung disease death rate highest in the winter but this finding was only available in one study. This study will investigate the trend and seasonal variations in hospital admission and mortality rates of ILD from 2006 to 2016.MethodFrom the Nationwide Inpatient Sample database, we collected all cases with the International Classification of Diseases (ICD)-9 or ICD-10 codes of ILD excluding identifiable external causes (drug, organic or inorganic dusts) from 2006 to 2016. Hospitalization rates of each year were calculated based on U.S Census population data. Monthly hospitalization and in-hospital mortality rates were analyzed by seasonal and trend decomposition.ResultsFrom 2006 to 2016, there was a downtrend in all cause hospital admissions but in-hospital mortality rate did not change, with or without the presence of pneumonia. Highest hospital admission rates of ILD per 100000 of population were from January to May. The average number of hospitalizations in spring, summer, fall and winter months were 7447.9 ± 932.0, 6643.0 ± 840.5, 6551.3 ± 922.6 and 7110.3 ± 866.1 respectively. All-cause in-hospital mortality ranges from 7.13% ± 0.79% in the summer to 8.13% ± 0.60% in the winter with winter months having the highest mortality rate (p=0.018). The seasonal variations of hospital admission and mortality was not changed when infectious pneumonia cases were ruled out.ConclusionFrom 2006 to 2016, admission rates of ILD declined but in-hospital mortality remained unchanged. All-cause hospital admissions and mortality of ILD have a strong seasonal variation. Hospital admissions are highest in the period from January to May, in-hospital death was highest in the winter.

Download Full-text

Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3167 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Arroyo-Espliguero ◽

M.C Viana-Llamas ◽

A Silva-Obregon ◽

A Estrella-Alonso ◽

C Marian-Crespo ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Primary Angioplasty ◽

Prognostic Impact ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Kaplan Meier ◽

St Segment ◽

One Year ◽

The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI<97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P<0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P<0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P<0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

Download Full-text

Total numbers and in-hospital mortality of patients with myocardial infarction in Germany during the FIFA soccer world cup 2014

Scientific Reports ◽

10.1038/s41598-021-90582-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Karsten Keller ◽

Lukas Hobohm ◽

Volker H. Schmitt ◽

Martin Engelhardt ◽

Philip Wenzel ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Environmental Stress ◽

Nationwide Inpatient Sample ◽

Hospital Admissions ◽

Patient Characteristics ◽

World Cup ◽

National Team ◽

Comparison Period

AbstractEnvironmental stress like important soccer events can induce excitation, stress and anger. We aimed to investigate (i) whether the FIFA soccer world cup (WC) 2014 and (ii) whether the soccer games of the German national team had an impact on total numbers and in-hospital mortality of patients with myocardial infarction (MI) in Germany. We analyzed data of MI inpatients of the German nationwide inpatient sample (2013–2015). Patients admitted due to MI during FIFA WC 2014 (12th June–13th July2014) were compared to those during the same period 2013 and 2015 (12th June–13th July). Total number of MI patients was higher during WC 2014 than in the comparison-period 2013 (18,479 vs.18,089, P < 0.001) and 2015 (18,479 vs.17,794, P < 0.001). WC was independently associated with higher MI numbers (2014 vs. 2013: OR 1.04 [95% CI 1.01–1.07]; 2014 vs. 2015: OR 1.07 [95% CI 1.04–1.10], P < 0.001). Patient characteristics and in-hospital mortality rate (8.3% vs. 8.3% vs. 8.4%) were similar during periods. In-hospital mortality rate was not affected by games of the German national team (8.9% vs. 8.1%, P = 0.110). However, we observed an increase regarding in-hospital mortality from 7.9 to 9.3% before to 12.0% at final-match-day. Number of hospital admissions due to MI in Germany was 3.7% higher during WC 2014 than during the same 31-day period 2015. While in-hospital mortality was not affected by the WC, the in-hospital mortality was highest at WC final.

Download Full-text