Abstract P091: Temporal Trends in Incidence of Acute Myocardial Infarction and Revascularization in People With and Without Mental Illness

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Lauren Bresee ◽  
Marcello Tonelli ◽  
Braden Manns ◽  
Brenda Hemmelgarn
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mental Illness ◽  
Mood Disorder ◽  
Psychotic Disorder ◽  
Mentally Ill ◽  
Artery Bypass ◽  
Temporal Trends ◽  
Relative Decrease ◽  
Over Time

Objective: The objective of this study was to evaluate the temporal trends in the incidence of acute myocardial infarction (AMI) and receipt of revascularization procedures in people with and without mental illness. Hypothesis: Individuals with mental illness will have higher rates of AMI, and lower rates of revascularization compared to people without mental illness. Methods: We did a population-based study using provincial administrative data from April 1, 1998 until March 31, 2009. We identified individuals 20 years of age and older as having mental illness (psychotic disorder [PD] or mood disorder [MD]) based on physician billing claims and hospitalization data, and compared them to those without mental illness by this definition. We identified incident AMI using a validated algorithm applied to hospitalization data. We used procedure codes to identify receipt of cardiac catheterization, coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA) in those with incident AMI. Rates were age-adjusted using the 2001 Canadian census population to perform direct standardization. Relative change over time was calculated by comparing rates in 2009 to rates in 1998. Results: A total of 3,639,480 subjects were included, of whom 576,411 (15.8%) had a mood disorder only, 38,116 (1.0%) had a psychotic disorder only, and 72,430 (2.0%) had both a MD and PD. People with MD were more likely to be female, whereas those with PD were older, than the other mentally ill and non-mentally ill populations. Incidence of AMI was highest in people with PD (210 per 100,000 in 2009) and lowest in people without mental illness (160 per 100,000 in 2009), however, incidence of AMI decreased over time in all groups. Use of catheterization decreased over time in people with MD (19% relative decrease) and PD (25% relative decrease), while increasing in people without mental illness (10.8% relative increase). Use of PTCA increased in all groups except people with PD (21.1% relative decrease). Conclusions: Incidence of AMI decreased over time in people with and without mental illness, however, people with mental illness consistently had a higher incidence of AMI compared to individuals without mental illness. Use of catheterization and PTCA increased in people without mental illness while decreasing in people with PD over the study period.

scholarly journals Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
André Åström ◽  
Lars Söderström ◽  
Thomas Mooe
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Incidence Rates ◽  
P2y12 Inhibitors ◽  
Over Time

AbstractOnly sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.

Higher case fatality after cardiovascular event for patients with comorbid psychiatric disease

2011 ◽  
Vol 26 (S2) ◽  
pp. 385-385
Author(s):  
B. Lindelius ◽  
E. Bjorkenstam ◽  
C. Dahlgren ◽  
R. Ljung
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Mental Illness ◽  
Cardiovascular Event ◽  
Mentally Ill ◽  
Case Fatality ◽  
Psychiatric Disease ◽  
Adequate Treatment ◽  
Somatic Illness

IntroductionThe National Board of Health and Welfare in Sweden has recently published regional comparisons and assessment o the psychiatric care in Sweden. More than 30 health care quality indicators are used that comprises processes and results of the care for the mentally ill. There are indications that psychiatric patients do not receive adequate treatment of their somatic illness. The study exemplifies that.ObjectivesTo investigate whether patients with mental disorders are more likely to die after being hospitalized for acute myocardial infarction or stroke.AimsTo pinpoint possible disparities in physical health outcomes/mortality among patients with mental illness.MethodPatients were identified in the National Patient Register and Cause of Death Register. Mental illness was defined as having a registered psychiatric main diagnose at least once in the past five years.ResultsIn 2007 30% of the patients in total that had an acute myocardial infarction died witin 28 days. Among patients that also had psychiatric diagnose 44% died within 28 days. Case fatality within 28 days after a stroke was 22% and 34% respectively. There are differences in outcome between the regions.ConclusionsOur study indicates that the case fatality after a cardiovascular event is much higher in patients with comorbid psychiatric disease. Many reasons can be plausible, including bad compliance to treatment. But the higher case fatality might also be an indicator of non-optimal processes within the health care system for mentally ill people.

Temporal Trends in Drug Abuse in Adults with Acute Myocardial Infarction Show Worse Outcomes

2017 ◽  
Vol 41 (S1) ◽  
pp. s247-s247
Author(s):  
Z. Mansuri ◽  
S. Patel ◽  
P. Patel ◽  
O. Jayeola ◽  
A. Das ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Drug Abuse ◽  
Hospital Admissions ◽  
Artery Bypass ◽  
Temporal Trends ◽  
International Classification Of Diseases ◽  
Specialty Care ◽  
Trend Test ◽  
Invasive Treatment

ObjectiveTo determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults.BackgroundDA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA.ConclusionsWe demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Increased Prevalence of Psychosis in Patients Who Get Admitted with Acute Myocardial Infarction with Worse Outcomes

2017 ◽  
Vol 41 (S1) ◽  
pp. s247-s247
Author(s):  
Z. Mansuri ◽  
S. Patel ◽  
P. Patel ◽  
O. Jayeola ◽  
A. Das ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Admissions ◽  
Artery Bypass ◽  
Temporal Trends ◽  
Coronary Intervention ◽  
International Classification Of Diseases ◽  
Trend Test ◽  
Classification Of Diseases ◽  
Competing Interest

ObjectiveTo determine trends and impact on outcomes of acute myocardial infarction (AMI) in patients with pre-existing psychosis.BackgroundWhile post-AMI psychosis has been extensively studied, contemporary studies including temporal trends on impact of pre-AMI Psychosis on AMI and post-AMI outcomes are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project(HCUP) from 2002 to 2012. We identified AMI and psychosis as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.77% had psychosis. Proportion of hospitalizations with psychosis increased from 6.94% to 11.85% (P-trend < 0.001). Utilization of percutaneous coronary intervention (PCI) was lower in patients with psychosis (29.98% vs. 40.36%, P < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with psychosis (8.01% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with psychosis (aOR 0.677; 95% CI 0.630–0.727; P < 0.001) but discharge to specialty care higher (aOR 1.870; 95%CI 1.786–1.958; P < 0.001). In addition, median length of hospitalization (3.77 vs. 2.90 days; P < 0.001) was higher in hospitalizations with psychosis.ConclusionsOur study displayed increasing proportion of patients with psychosis admitted due to AMI in last decade with lower mortality but higher morbidity post-infarction, and significantly less utilization of PCI and CABG. There was also increased length of stay patients with MDD. There is need to explore reasons behind this disparity in outcomes and PCI and CABG utilization to improve post-AMI outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Use of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE—Retrospective AMI Study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033269
Author(s):  
Xianqiang Wang ◽  
Xue Du ◽  
Hao Yang ◽  
Emily Bucholz ◽  
Nicholas Downing ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Magnesium Sulfate ◽  
Urban Areas ◽  
Temporal Trends ◽  
Sampling Strategy ◽  
Reperfusion Therapy ◽  
Intravenous Magnesium ◽  
Nationally Representative ◽  
Over Time

ObjectiveIn 2001, Chinese guidelines for the care of acute myocardial infarction (AMI) included a new recommendation against the routine use of magnesium. We studied temporal trends and institutional variation in the use of intravenous magnesium sulfate in nationally representative samples of individuals hospitalised with AMI in China between 2001 and 2015.MethodsIn an observational study (China PEACE—Retrospective Study) of AMI care, we used a two-stage, random sampling strategy to create a nationally representative sample of 28 208 patients with AMI at 162 Chinese hospitals in 2001, 2006, 2011 and 2015. The main outcome is use of intravenous magnesium sulfate over time.ResultsWe identified 24 418 patients admitted for AMI, without hypokalaemia, in the four study years. Over time, there was a significant initial decrease in intravenous magnesium sulfate use, from 32.1% in 2001 to 17.1% in 2015 (p<0.001 for trend). The decline was greater in the Eastern (from 33.3% to 16.5%) and Western (from 34.8% to 17.2%) regions, as compared with the Central region (from 25.9% to 18.1%), with little difference between rural and urban areas. The proportion of hospitals using intravenous magnesium sulfate did not change over time (from 81.3% to 77.9%). The median ORs, representing hospital-level variation, were 6.03 in 2001, 3.86 in 2006, 4.26 in 2011 and 4.72 in 2015. Intravenous magnesium sulfate use was associated with cardiac arrest at admission and receipt of reperfusion therapy, but no hospital-specific characteristics.ConclusionsDespite recommendations against its use, intravenous magnesium sulfate is used in about one in six patients with AMI in China. Our findings highlight the need for more efficient mechanisms to stop using ineffective therapies to improve patients’ outcomes and reduce medical waste.Trial registration numberClinicalTrials.gov (NCT01624883)

P4391Cardiovascular risk factor trends over two decades in patients presenting with acute myocardial infarction: a failure of smoking control, especially in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Witassek ◽  
D Radovanovic ◽  
H Rickli ◽  
G Pedrazzini ◽  
P Erne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Temporal Trends ◽  
P Value ◽  
Chi Square ◽  
Men And Women ◽  
The Mean ◽  
Smoking Control ◽  
Over Time

Abstract Background Hypertension, diabetes, dyslipidemia and smoking are established cardiovascular risk factors (CVRF). Little is known about the changes of risk factor profiles over time in patients presenting with acute myocardial infarction (AMI). Purpose To analyze the temporal trends of CVRF in patients presenting with AMI over the last 22 years in Switzerland. Methods We included data of all AMI patients enrolled between 1997 and 2018 in the Swiss nationwide AMIS Plus registry. The rates of hypertension, diabetes, dyslipidemia and smoking at presentation were descriptively analyzed dividing the data into 2-year periods. Trend analyses were performed using the CHI-square-test and ANOVA. A p-value of <0.005 was considered as statistically significant. Results A total of 57,995 patients were included in the analysis (73.6% male). The mean age was 66.0 years (males: 64.0 years, females 71.6 years) and did not differ over the study period. The mean CVRF rates over the study period were as follows: diabetes 20.5% (males: 19.4%, females: 23.6%), hypertension 60.2% (males: 57.0%, females: 69.0%), dyslipidemia 59.4% (males: 60.5%, females: 56.4%), and smoking 39.3% (males: 43.0%, females: 28.7%). While there was no significant change over time in the rates of diabetes for both genders, there were significant increases in the rates of hypertension and dyslipidemia for both males and females (p<0.001 for all comparisons). In terms of smoking, there was no significant trend for males while there was a significant increase in the rate of smoking for females (p<0.001). As a result, the gap in smoking rates between men and women decreased from 19.9% (45.3% vs. 25.4%) in 1997/98 to 7.9% (41.2% vs. 33.3%) in 2017/18. Trends in the rate of smokers Conclusions Among patients presenting with AMI in Switzerland over two decades, the prevalence of hypertension and dyslipidemia increased in both men and women, while diabetes at presentation did not change over the years. We documented a failure of smoking control, with a lack of a reduction in the smoking prevalence among males and a striking increase among women.

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