Abstract 6082: Sex Differences in Mortality after Acute Myocardial Infarction: Changes from 1994 to 2006

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Viola Vaccarino ◽  
Lori Parsons ◽  
Eric D Peterson ◽  
William J Rogers ◽  
Catarina Kiefe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Excess Mortality ◽  
Age Groups ◽  
Case Fatality ◽  
Patient Characteristics ◽  
National Registry ◽  
Mortality Trends ◽  
Younger Women ◽  
Study Population

Introduction. In the past 10 years, several studies have shown that younger, but not older, women have a higher hospital mortality than age-matched men. We examined whether such mortality differences have declined in recent years. Methods. We investigated temporal tends in the case fatality of MI according to sex and age (in 5 age groups) during a12-year period, 1994 to 2006. The study population included 916,380 MI patients from the National Registry of Myocardial Infarction (NRMI) who had a confirmed diagnosis of MI. Results. Hospital mortality declined markedly between 1994 and 2006 in all patients, but more so in women than in men in virtually every age group. The mortality reduction in 2006 relative to 1994 was largest in women <55 years old (53%) and lowest in men <55 years old (33%). In patients <55 years, the absolute decline in mortality was 3 times larger in women than in men (2.7% vs 0.9%). The sex difference in mortality decline became progressively lower in older patients (p=0.002 for the interaction between sex, age and year). As a result, the excess mortality in younger women compared with men was less pronounced in 2004 – 06 than in 1994 –95 (Figure ). Changes in patient characteristics and treatments over time accounted in part for these mortality trends. Conclusion. In recent years, women, particularly younger women, experienced larger improvements in hospital mortality after MI than men. As a result, the higher mortality of younger MI women compared with men has narrowed.

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

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.

scholarly journals MYOCARDIAL INFARCTION SYMPTOM PRESENTATION AND HOSPITAL MORTALITY: RELATIONSHIP TO AGE AND SEX IN THE NATIONAL REGISTRY OF MYOCARDIAL INFARCTION (NRMI)

2010 ◽  
Vol 55 (10) ◽  
pp. A125.E1175
Author(s):  
John G. Canto ◽  
William J. Rogers ◽  
Robert J. Goldberg ◽  
Eric D. Peterson ◽  
Nanette K. Wenger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
National Registry ◽  
Symptom Presentation ◽  
Age And Sex

Abstract MP29: Patient Characteristics And Outcomes Associated With In-hospital Onset Of Acute Decompensated Heart Failure

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Corey A Kalbaugh ◽  
Patricia P Chang ◽  
Kunihiro Matsushita ◽  
Sunil K Agarwal ◽  
Melissa Caughey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Acute Decompensated Heart Failure ◽  
Case Fatality ◽  
Patient Characteristics ◽  
Decompensated Heart Failure ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
One Year

Introduction: There has been little focus on hospitalized acute decompensated heart failure (ADHF) that develops after admission, which may occur because of comorbid conditions, over-administration of fluid or post-surgical complications. Aims: To compare patient characteristics, case fatality, and hospital length of stay (LOS) associated with ADHF that develops after hospital admission as compared to those with ADHF at admission. Methods: Hospitalizations with possible ADHF were sampled, based on HF ICD codes, among those aged > 55 years from the four communities of the Atherosclerosis Risk in Communities Study (2005-2010). Medical records were abstracted with events classified by physician panel or computer classified. Case fatality was obtained through the National Death Index. We identified 4,503 (unweighted) events with definite/probable ADHF, after excluding those with unknown time of decompensation (n=81), hospital transfers (n=102), and race other than black or white (n=118). Demographic and clinical characteristics were compared by ADHF onset (at/after admission). Logistic regression was used to evaluate the association of ADHF onset with in-hospital mortality, and 28-days and one-year mortality, adjusted for demographics and comorbidity. Linear regression was used to evaluate the association of ADHF onset with log-transformed hospital LOS, adjusted for demographics. All analyses were weighted to account for the stratified sampling design. Results: Of 21,052 (weighted) ADHF events, 7.4% (n=1561) developed ADHF after admission. Patients with ADHF occurring after admission were older (mean: 79 vs. 75 years), and more likely white and female. Those with ADHF at admission were more likely to have a positive smoking history, COPD, and to be on dialysis. Presence of diabetes, hypertension and coronary artery disease were not significantly different between groups. In hospital mortality (16.5% vs. 6.3%; OR= 2.7, 95% CI=1.9-3.8) and 28-day mortality (23.9% vs. 10.1%; OR= 2.4, 95% CI=1.7-3.4) was higher among those who developed ADHF after admission. One-year case fatality was similar (39.4% vs. 33.6%; OR= 1.2, 95% CI=0.9-1.6). Unadjusted mean LOS was longer for those with ADHF occurring after admission (12.8 days, 95% CI=11.8-13.8) than those with ADHF at admission (7.2 days, 95% CI=6.8-7.6). The adjusted and geometric mean LOS was 1.3 days (95% CI=1.2-1.4) longer for those who developed ADHF after admission. Conclusion: Although patients with ADHF onset after admission were slightly older, differences in comorbidity do not indicate an easily identifiable subgroup for closer in-hospital monitoring. Development of ADHF after admission was associated with an alarmingly high early case fatality and longer hospital LOS compared to those with ADHF at hospital admission.

Abstract 2399: Low Hospital Mortality Of Acute Myocardial Infarction In Cslinical Practice Due To Optimized Guideline Oriented Treatment: Results Of The Optami-registry

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Anselm K Gitt ◽  
Harm Wienbergen ◽  
Uwe Zeymer ◽  
Frank Towae ◽  
Martin G Gottwik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Practice ◽  
Hospital Mortality ◽  
Randomized Trials ◽  
Patient Characteristics ◽  
High Rate ◽  
Internal Quality ◽  
Acute Therapy ◽  
Early Invasive Strategy

Background: Hospital mortality of STEMI in recent randomized trials as ASSENT IV ranges between 3.5 and 6.0%. Although registry data have shown a constant improvement of myocardial infarction outcome over the past years due to better implementation of guidelines for the management of acute myocardial infarction, hospital mortality in clinical practice still was much higher than in the selected patient population of randomized trials. Can ongoing registries in clinical practice as quality assurance programmes further reduce hospital mortality of acute myocardial infarction? Methods: The OPTAMI Register (Optimized Therapy of Acute Myocardial Infarction) enrols consecutive patients with STEMI or NSTEMI in 33 Centres (27 with cathlab facilities) in Germany to document patient characteristics, acute therapy as well as hospital outcome. All centres are provided benchmark reports for internal quality control. Results: Out of 1139 enrolled patients, 629 (55%) presented with STEMI and 510 (45%) with NSTEMI. Patients with NSTEMI were older, more often female and had a significantly higher prevalence of relevant comorbidities. OPTAMI documented an extraordinary high rate of primary PCI in STEMI as well as a high rate of early invasive strategy with PCI <48h in NSTEMI. In both groups, adherence to guidelines for the acute adjunctive medical treatment including antiplatelet therapy, betablockers, ACE-inhibitors and statins was higher than ever documented in any German MI registry. Hospital mortality was 4.0% in consecutive patients with STEMI and 3.9% in consecutive patients with NSTEMI. Conclusion: Preliminary data of the ongoing OPTAMI Registry demonstrate that in selected cnetres (mainly with cath lab facilities) hospital mortality in clinical practice can be reduced to levels of randomised controlled trials by adherence to practice guidelines for the management of acute myocardial infarctions.

P3614Impact of renal dysfunction in patients with acute myocardial infarction on early management and outcome: a first observational French study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Bernard ◽  
C El Khoury ◽  
L Fraticelli
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Hospital Mortality ◽  
Real Life ◽  
Patient Characteristics ◽  
Hospital Treatment ◽  
Kidney Dysfunction ◽  
Early Management ◽  
St Segment Elevation ◽  
One Year

Abstract Background Kidney dysfunction (KD) is largely associated to cardiovascular mortality. Purpose Analyse early management and outcome in real life of ST segment elevation myocardial infarction (STEMI) patients with KD compared to STEMI patients with normal renal function. Methods Using 10 years' data from OSCAR regional registry, we investigated the early management and outcome of all patients with STEMI. Kidney dysfunction (KD) has been defined by creatinine clearance (CrCl) <90mL/min and was assessed using Cockcroft-Gault (CG) equation. Among them, two groups were identified: patients with normal kidney function (NKF) (CrCl ≥90mL/min) and patients with KD (CrCl <90mL/min). KD patients were stratified into 3 groups: patients with mild KD (CrCl 60–90mL/min), patients with moderate KD (CrCl 30–60mL/min) and patients with severe KD (CrCl <30mL/min). The comparison of the groups concerned patient characteristics, therapeutic strategy and follow-up at 1, 6 and 12 months. Results Our study included 8 003 STEMI patients from 2009 to 2018, 4 234 (52.9%) of them with KD. Among these, 2441 (57.6%) patients had mild KD, 1494 (35.3%) moderate KD and 299 (7.1%) severe KD. NKF patients were younger than KD group (54 [48–61] vs 72 [63–81]). KD patients had more cardiovascular risk factors such as diabetes, hypertension and personal history of coronary disease (p<0.001), but were less smokers (p<0,001). KD patients presented less often chest pain, and more dyspnea or cardiac arrest (p<0,001). There was no difference in symptom-first medical contact delay (p=0.30). More than 14% of patients with KD presented with Killip≥2. In the KD group location of infarction was more often anterior and lateral. In-hospital treatment differed among the groups: KD patients received less prasugrel (11% vs 20%), ticagrelor (44% vs 49%), enoxaparin (70% vs 80%), morphine (29% vs 39%) or other analgesic (30% vs 35%), but more clopidogrel (33% vs 23%), diuretics (3% vs 0,7%) and catecholamines (5% vs 2%) (p<0.001). In-hospital mortality was higher in the KD group (9% vs 1%, p<0.001). One-year mortality was 14% in the KD group compared to 2% for patients with NKF (p<0.001). Also, in-hospital mortality was increasing exponentially with KD severity (2%, 8% and 24% for mild, moderate and severe KD) (p<0,001) as well as 1-year mortality (respectively 1%, 6% and 12% after 1 year) (p<0,001). Conclusion Kidney insufficiency is an independent risk factor for death in patients after myocardial infarction and was associated with poor prognosis at short- and long-term. We observed that mortality increased with KD severity. Despite a high cardiovascular risk, KD patients presenting STEMI are less likely to receive therapy, while having more co-morbidities and extended infarction. To achieve an optimal medical care of KD patients with STEMI, we should introduce evidence-based therapies in the acute phase.

scholarly journals Assessing excess mortality in Vienna and Austria after the first year of the COVID-19 pandemic

2022 ◽  
Author(s):  
Ramon Bauer ◽  
Markus Speringer ◽  
Peter Frühwirt ◽  
Roman Seidl ◽  
Franz Trautinger
Keyword(s):  
Excess Mortality ◽  
Heat Waves ◽  
National Level ◽  
Age Groups ◽  
Prediction Intervals ◽  
First Year ◽  
Expected Number ◽  
Mortality Trends ◽  
The Public ◽  
Definition Of

In Austria, the first confirmed COVID-19 death occurred in early March 2020. Since then, the question as to whether and, if so, to what extent the COVID-19 pandemic has increased overall mortality has been raised in the public and academic discourse. In an effort to answer this question, Statistics Vienna (City of Vienna, Department for Economic Affairs, Labour and Statistics) has evaluated the weekly mortality trends in Vienna, and compared them to the trends in other Austrian provinces. For our analysis, we draw on data from Statistics Austria and the Austrian Agency for Health and Food Safety (AGES), which are published along with data on the actual and the expected weekly numbers of deaths via the Vienna Mortality Monitoring website. Based on the definition of excess mortality as the actual number of reported deaths from all causes minus the expected number of deaths, we calculate the weekly prediction intervals of the expected number of deaths for two age groups (0 to 64 years and 65 years and older). The temporal scope of the analysis covers not only the current COVID-19 pandemic, but also previous flu seasons and summer heat waves. The results show the actual weekly numbers of deaths and the corresponding prediction intervals for Vienna and the other Austrian provinces since 2007. Our analysis underlines the importance of comparing time series of COVID-19-related excess deaths at the sub-national level in order to highlight within-country heterogeneities.

scholarly journals In-hospital mortality of acute myocardial infarction in patients with and without renal dysfunction

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Abdul Rehman Abid ◽  
Muhammad Tahir Mohyuddin ◽  
Liaqat Ali ◽  
Muhammad Shahid Naveed ◽  
Nadeem Hayat Mallick
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Renal Insufficiency ◽  
Renal Disease ◽  
Hospital Mortality ◽  
Renal Dysfunction ◽  
End Stage Renal Disease ◽  
Study Population ◽  
Stage Renal Disease ◽  
End Stage

Objective: To compare in-hospital mortality of acute myocardial Infarction in patients having normal renal functions with renal dysfunction patients. Setting: Emergency ward, Coronary care units and cardiology wards of the Punjab Institute of Cardiology Lahore. Study design: It was a comparative study. Sample size: 1000 consecutive patients presenting with acute myocardial infarction admitted to the Punjab Institute of cardiology Lahore were studied from 1st March 2004 to 15th August 2004. Results: After fulfilling the inclusion criteria 1000 patients were studied. The mean age of the study population was 60.8+9.38 years. Total number of males in the study population was 642(64.2%) while female patients were 358(35.8%). Patients with any degree of renal dysfunction, except those with end-stage renal disease were more likely to present with anterior MI than were patients without renal dysfunction. Patients with end-stage renal disease and more severe renal dysfunction were more likely to develop heart failure during hospitalization, to experience atrial fibrillation, and to have mechanical complications. Streptokinase therapy was used less frequently in patients with any degree of renal dysfunction than in patients without renal dysfunction, despite a similar incidence of MI. In-hospital mortality was 51(12%) in Group I patients, 46(16.6%) in Group II patients, 36(22%) in Group III patients, 35(27.7%) in Group IV patients and 5(35.7%) in Group V patients with a p value of <0.0001. Severe renal insufficiency had the maximum in-hospital mortality with OR of 5.4 and 95% confidence interval of 2.9-10.3 followed by end stage renal disease OR 5.1 (CI 2.2-12.1), moderate renal insufficiency OR 4.1 (CI 2.3-7.2) and mild renal insufficiency OR 1.9(CI 1.1-3.1) with a p value of <0.0001. Similarly congestive heart failure during hospital stay was observed in 20(4.7%) patients in Group I, 17(6.1%) patients in Group II, 15(9.4%) patients in Group III, 16(12.6%) patients in Group IV and 4(28.6%) patients in Group V. Similar trends were observed in mechanical complications and post myocardial arrhythmias in the study population, Conclusion: Patients with renal dysfunction who have acute MI are a high-risk population and suffer from increased mortality once they are admitted to the hospital. This is because of presence of more risk factors in this sub set of patients.

scholarly journals Epidemiology and Trends of Sepsis in Young Adults Aged 20–44 Years: A Nationwide Population-Based Study

2019 ◽  
Vol 9 (1) ◽  
pp. 77
Author(s):  
Carmen Bouza ◽  
Teresa López-Cuadrado
Keyword(s):  
Young Adults ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Case Fatality ◽  
Population Based ◽  
Incidence Rates ◽  
Mortality Trends ◽  
Crude Incidence ◽  
Source Of Infection ◽  
Primary Endpoints

Background: While sepsis may have especially marked impacts in young adults, there is limited population-based information on its epidemiology and trends. Methods: Population-based longitudinal study on sepsis in adults aged 20–44 years using the 2006–2015 Spanish national hospital discharge database. Cases are identified by an ICD-9-CM coding strategy. Primary endpoints are incidence and in-hospital mortality. Trends are assessed for annual percentage change (AAPC) in rates using Joinpoint regression models. Results: 28,351 cases are identified, representing 3.06‰ of all-cause hospitalisations and a crude incidence of 16.4 cases/100,000 population aged 20–44. The mean age is 36 years, 58% of cases are men, and around 60% have associated comorbidities. Seen in one third of cases, the source of infection is respiratory. Single organ dysfunction is recorded in 45% of cases. In-hospital mortality is 24% and associated with age, comorbidity and extent of organ dysfunction. Incidence rates increase over time in women (AAPC: 3.8% (95% CI: 2.1, 5.5)), whereas case-fatality decline with an overall AAPC of −5.9% (95% CI −6.6, −5.2). Our results indicate that sepsis is common in young adults and associated with high in-hospital mortality, though it shows a decreasing trend. The substantial increase in incidence rates in women needs further research.

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