Among patients who survived acute myocardial infarction (AMI), 10-year mortality rates and hospitalization due to recurrence rates decreased. However, long-term outcomes were noticeably different in demographic subgroups. These findings were published in the Journal of the American Medical Association Cardiology.
Researchers sought to investigate 10-year all-cause mortality and hospitalization due to recurrence trends according to demographic subgroups, and to evaluate associations between recurrence and death. To accomplish this, they conducted a retrospective study of US Medicare fee-for-service beneficiaries from 1995 to 2019 that included almost 4 million AMI survivors (aged 78.0±7.4 years; 49.0% women). The 10-year mortality rate was 72.7% (95% CI, 72.6-72.7) and the 10-year recurrent AMI rate was 27.1% (95% CI, 27.0-27.2). Adjusted annual reductions for mortality were 1.5% (95% CI, 1.4-1.5) and for recurrence they were 2.7% (95% CI, 2.6-2.7).
With patient characteristics balanced, hazard ratios (HRs) for mortality and recurrence in men vs women were 1.13 (95% CI, 1.12-1.13) and 1.07 (95% CI, 1.06-1.07); in Black vs White patients they were 1.05 (95% CI, 1.05-1.06) and 1.08 (95% CI, 1.07-1.09); in other races (including American Indian and Alaska Native, Asian, Hispanic, other race or ethnicity, and unreported) vs White patients they were 0.96 (95% CI, 0.95-0.96) and 1.00 (95% CI, 1.00-1.01); in dual Medicare-Medicaid-eligible vs non-dual Medicare-Medicaid-eligible patients they were 1.24 (95% CI, 1.24-1.24) and 1.21 (95% CI, 1.20-1.21); and in patients in health priority areas vs other areas they were 1.06 (95% CI, 1.06-1.07) and 1.00 (95% CI, 1.00-1.01), respectively.
Among patients hospitalized in the final 3 years that included 10-year follow-up data (2007-2009), 10-year mortality risk was reduced 13.9% from patients hospitalized between 1995 and 1997 (adjusted HR [aHR], 0.86; 95% CI, 0.85-0.87), and there was a 22.5% drop in the 10-year recurrence risk (aHR, 0.77; 95% CI, 0.76-0.78). Death in the 10-year follow-up was greater among patients with recurrent AMI (80.6%; 95% CI, 80.5-80.7) vs no recurrence (72.4%; 95% CI, 72.3-72.5).
Study limitations include study subjects being only Medicare fee-for-service beneficiaries and at least 66 years of age, the inability to present Hispanic ethnicity as a subgroup, a change in Medicare coding in 2011, a decrease in the percentage of patients in the Medicare fee-for-service program over the study years, and missing data on those patients with recurrent events who were not hospitalized.
Researchers noted that, “10-year mortality and hospitalization for recurrence rates improved over the last decades for patients who survived the acute period of AMI.” They noted the significant outcome differences across demographics (“Men, Black patients, and dual Medicare-Medicaid–eligible patients had higher risks of adverse outcomes, and significant annual reductions in 10-year outcomes,”) and urged that dealing with the inequities in long-term outcomes be prioritized.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Wang Y, Leifheit EC, Krumholz HM. Trends in 10-year outcomes among Medicare beneficiaries who survived an acute myocardial infarction. JAMA Cardiol. Published online May 4, 2022. doi:10.1001/jamacardio.2022.0662