There are limited contemporary data available describing the characteristics of patients
who neither died nor were readmitted to the hospital during the first year after hospital
discharge for an acute myocardial infarction (AMI) in comparison with those who died
and/or were readmitted to the hospital during this high-risk period. Residents of
the Worcester, Massachusetts, metropolitan area discharged after an AMI from 3 central
Massachusetts hospitals on a biennial basis from 2001 to 2011 comprised the study
population. The average age of this population (n = 4,268) was 69 years, 62% were
men, and 92% were white. From 2001 to 2011, 43.5% of patients were classified as low-risk
survivors of an AMI, 12.3% died, and 44.2% did not die but had at least 1 rehospitalization
during the subsequent year. The proportion of low-risk survivors increased from 42.6%
to 46.4%, whereas the proportion of those who died within a year after hospital discharge
decreased from 14.3% to 10.5%, respectively, during the years under study. After adjusting
for several patient characteristics, younger (≤65 years) persons, men, those who were
married, those who did not present with multimorbidities, and patients who did not
develop in-hospital clinical complications were more likely to be classified as a
low-risk AMI survivor. Identifying low-risk survivors of an AMI may help health care
providers to focus more intensive efforts and interventions on those at higher risk
for dying and/or being readmitted to the hospital during the postdischarge transition
period after an AMI.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart Disease and Stroke Statistics—2014 update: a report from the American Heart Association.Circulation. 2014; 129: e28-e29
- Acute myocardial infarction hospitalization in the United States, 1979 to 2005.Am J Med. 2010; 123: 259-266
- Late-life factors associated with healthy aging in older men.J Am Geriatr Soc. 2014; 62: 880-888
- Midlife risk factors and healthy survival in men.JAMA. 2006; 296: 2343-2350
- Cardiovascular risk factors predictive for survival and morbidity-free survival in the oldest-old Framingham Heart Study participants.J Am Geriatr Soc. 2005; 53: 1944-1950
- Successful aging: the contribution of early-life and midlife risk factors.J Am Geriatr Soc. 2008; 56: 1098-1105
- Thirty-day rehospitalizations after acute myocardial infarction. A cohort study.Ann Intern Med. 2012; 157: 11-18
- The importance of clinical severity in the measurement of hospital readmission rates for Medicare beneficiaries, 1997-2007.Med Care Res Rev. 2013; 70: 653-665
- Statistical models and patient predictors of readmission for acute myocardial infarction: a systematic review.Circ Cardiovasc Qual Outcomes. 2009; 2: 500-507
- Trends in postdischarge mortality and readmissions: has length of stay declined too far?.Arch Intern Med. 2004; 164: 538-544
- Hospital readmission as an accountability measure.JAMA. 2011; 305: 504-505
- Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981): the Worcester Heart Attack Study.JAMA. 1986; 255: 2774-2779
- Incidence and case fatality rates of acute myocardial infarction (1975–1984): the Worcester Heart Attack Study.Am Heart J. 1988; 115: 761-767
- A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective.J Am Coll Cardiol. 1999; 33: 1533-1539
- A 30-year perspective (1975–2005) into the changing landscape of patients hospitalized with initial acute myocardial infarction: Worcester Heart Attack Study.Circ Cardiovasc Qual Outcomes. 2009; 2: 88-95
- Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI.Am J Med. 2011; 124: 40-47
- 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2012; 60: 645-681
- 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.J Am Coll Cardiol. 2013; 61: e78-e140
- Recent trends in the incidence rates of and death rates from atrial fibrillation complicating initial acute myocardial infarction: a community-wide perspective.Am Heart J. 2002; 143: 519-527
- Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective.Circulation. 2009; 119: 1211-1219
- 30-year trends in heart failure in patients hospitalized with acute myocardial infarction.Am J Cardiol. 2011; 107: 353-359
- Twenty-year trends in the incidence of stroke complicating acute myocardial infarction: Worcester Heart Attack Study.Arch Intern Med. 2008; 168: 2104-2110
- Clinical predictors of late death in survivors of acute myocardial infarction.Tex Heart Inst J. 2009; 36: 24-30
- Predictors of ten-year event-free survival in patients with acute myocardial infarction (from the Adria, Bassano, Conegliano, and Padova Hospitals [ABC] study on myocardial infarction).Am J Cardiol. 2012; 109: 966-975
- Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model.JAMA Intern Med. 2013; 173: 632-638
- Long-term outcome and its predictors among patients with ST-segment elevation myocardial infarction complicated by shock: insights from the GUSTO-I trial.J Am Coll Cardiol. 2007; 50: 1752-1758
Article info
Publication history
Published online: March 01, 2016
Accepted:
February 16,
2016
Received in revised form:
February 16,
2016
Received:
December 4,
2015
Footnotes
Drs. Tisminetzky and Gurwitz are supported by Grant 1R24AG045050 from the National Institute on Aging, Advancing Geriatrics Infrastructure and Network Growth. Partial salary support was provided to Dr. Goldberg by the Grants 1U01HL105268–01, R01 HL35434, and R56HL035434 from National Institutes of Health.
See page 1556 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
