Faculty Opinions recommendation of Clinical Events After Discontinuation of β-Blockers in Patients Without Heart Failure Optimally Treated After Acute Myocardial Infarction: A Cohort Study on the French Healthcare Databases.

The risk of recurrent events among survivors of acute myocardial infarction (AMI) is understudied. The aim of this analysis was to investigate the role of residual high thrombotic risk (HTR) as a predictor of recurrent in-hospital events after AMI. This retrospective cohort study included 186,646 patients admitted with AMI from 2009 to 2010 in all Italian hospitals who were alive 30 days after the index event. HTR was defined as at least one of the following in the 5 years preceding AMI: previous myocardial infarction, ischemic stroke/other vascular disease, type 2 diabetes mellitus, renal failure. Risk adjustment was performed in all multivariate survival analyses. Rates of major cardiac and cerebrovascular events (MACCE) within the following 5 years were calculated in both patients without fatal readmissions at 30 days and in those free from in-hospital MACCE at 1 year from the index hospitalization. The overall 5-year risk of MACCE was higher in patients with HTR than in those without HTR, in both survivors at 30 days [hazard ratio (HR), 1.49; 95% confidence interval (CI), 1.45-1.52; p<0.0001] and in those free from MACCE at 1 year (HR, 1.46; 95% CI, 1.41-1.51; p<0.0001). The risk of recurrent MACCE increased in the first 18 months after AMI (HR, 1.49) and then remained stable over 5 years. The risk of MACCE after an AMI endures over 5 years in patients with HTR. This is also true for patients who did not have any new cardiovascular event in the first year after an AMI. All patients with HTR should be identified and addressed to intensive preventive care strategies.

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β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study

BMJ ◽

10.1136/bmj.i5602 ◽

2016 ◽

pp. i5602

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Β Blockers

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Gender disparities among hospitalised patients with acute myocardial infarction, acute decompensated heart failure or pneumonia: retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2018-022782 ◽

2019 ◽

Vol 9 (1) ◽

pp. e022782 ◽

Cited By ~ 4

Author(s):

Mouaz Alsawas ◽

Zhen Wang ◽

M Hassan Murad ◽

Mohammed Yousufuddin

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Cohort Study ◽

Retrospective Cohort ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Men And Women ◽

Hospitalised Patients ◽

Significant Difference

ObjectiveTo assess gender disparity in outcomes among hospitalised patients with acute myocardial infarction (AMI), acute decompensated heart failure (ADHF) or pneumonia.DesignA retrospective cohort study.SettingA tertiary referral centre in Midwest, USA.ParticipantsWe evaluated 12 265 adult patients hospitalised with ADHF, 15 777 with AMI and 12 929 with pneumonia, from 1 January 1995 through 31 August 2015. Patients were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes.Primary and secondary outcome measuresPrevalence of comorbidities, 30-day mortality and 30-day readmission. Comorbidities were chosen from the 20 chronic conditions, specified by the Office of the Assistant Secretary for Health. Logistic regression analysis was conducted adjusting for multiple confounders.ResultsPrevalence of comorbidities was significantly different between men and women in all three conditions. After adjusting for age, length of stay, multicomorbidities and residence, there was no significant difference in 30-day mortality between men and women in AMI or ADHF, but men with pneumonia had slightly higher 30-day mortality with an OR of 1.19 (95% CI 1.06 to 1.34). There was no significant difference in 30-day readmission between men and women with AMI or pneumonia, but women with ADHF were slightly more likely to be readmitted within 30 days with OR 0.90 (95% CI 0.82 to 0.99).ConclusionGender differences in the distribution of comorbidities exist in patients hospitalised with AMI, ADHF and pneumonia. However, there is minimal clinically meaningful impact of these differences on outcomes. Efforts to address gender difference may need to be diverted towards targeting overall population health, reducing race/ethnicity disparity and improving access to care.

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