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Characteristics, Management, and Short-Term Outcomes of Adults ≥65 Years Hospitalized With Acute Myocardial Infarction With Prior Anemia and Heart Failure

      Our study objectives were to examine the impact of anemia and heart failure (HF) on in-hospital complications, and postdischarge outcomes (7 and 30-day rehospitalizations and mortality) in adults ≥65 years hospitalized with acute myocardial infarction (AMI). We used multivariable-adjusted logistic regression models to examine the association between the presence of anemia and/or HF, and the examined outcomes. The study population consisted of 3,863 patients ≥65 years hospitalized with AMI at the 3 major medical centers in Worcester, MA, during 6 annual periods between 2001 and 2011. Individuals were categorized into 4 groups based on the presence of previously diagnosed anemia (hemoglobin ≤10 mg/dl) and/or HF: Those without these conditions (n = 2,300), those with anemia only (n = 382), those with HF only (n = 837), and those with both conditions (n = 344). The median age of the study population was 79 years and 49% were men. Individuals who had been previously diagnosed with anemia and HF had the highest proportion of older adults (≥85 years) and the lowest proportion of those who had received any cardiac interventional procedure during hospitalization. After multivariable adjustment, individuals who presented with both previously diagnosed conditions were at the greatest risk for experiencing adverse events. Patients who presented with HF only were at higher risk for developing several clinical complications during hospitalization, whereas those with anemia only were at slightly higher risk of being rehospitalized within 7-days of their index hospitalization. In conclusion, anemia and HF are prevalent chronic conditions that increased the risk of adverse events in older adults hospitalized with AMI.
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      References

        • Sabatine MS
        • Morrow DA
        • Giugliano RP
        • Burton PB
        • Murphy SA
        • McCabe CH
        Association of hemoglobin levels with clinical outcomes in acute coronary syndromes.
        Circulation. 2005; 111: 2042-2049
        • Lee WC
        • Fang HY
        • HC1 Chen
        • Chen CJ
        • Yang CH
        • Hang CL
        • Wu CJ
        • Fang CY
        Anemia: a significant cardiovascular mortality risk after ST-segment elevation myocardial infarction complicated by the comorbidities of hypertension and kidney disease.
        PLoS One. 2017; 12e0180165
        • Ariza-Solé A
        • Formiga F
        • Salazar-Mendiguchía J
        • Garay A
        • Lorente V
        • Sánchez-Salado JC
        • Sánchez-Elvira G
        • Gómez-Lara J
        • Gómez-Hospital JA
        • Cequier A
        Impact of anaemia on mortality and its causes in elderly patients with acute coronary syndromes.
        Heart Lung Circ. 2015; 24: 557-565
        • Younge JO
        • Nauta ST
        • Akkerhuis KM
        • Deckers JW
        • van Domburg RT
        Effect of anemia on short- and long-term outcome in patients hospitalized for acute coronary syndromes.
        Am J Cardiol. 2012; 109: 506-510
        • Roger VL.
        Epidemiology of heart failure.
        Circ Res. 2013; 113: 646-659
        • Wu AH
        • Parsons L
        • Every NR
        • Bates ER
        Second National Registry of Myocardial Infarction Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2).
        J Am Coll Cardiol. 2002; 40: 1389-1394
        • Roe MT
        • Chen AY
        • Riba AL
        • Goswami RG
        • Peacock WF
        • Pollack Jr, CV
        • Collins SP
        • Gibler WB
        • Ohman EM
        • Peterson ED
        • CRUSADE Investigators
        Impact of congestive heart failure in patients with non-ST-segment elevation acute coronary syndromes.
        Am J Cardiol. 2006; 97: 1707-1712
        • Goldberg RJ
        • Gore JM
        • Alpert JS
        • Dalen JE
        Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981): the Worcester Heart Attack Study.
        JAMA. 1986; 255: 2774-2779
        • Goldberg RJ
        • Gore JM
        • Alpert JS
        • Dalen JE
        Incidence and case fatality rates of acute myocardial infarction (1975–1984): the Worcester Heart Attack Study.
        Am Heart J. 1988; 115: 761-767
        • Goldberg RJ
        • Yarzebski J
        • Lessard D
        • Gore JM
        A two-decade (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
        • Floyd KC
        • Yarzebski J
        • Spencer FA
        • Lessard D
        • Dalen JE
        • Alpert JS
        • Gore JM
        • Goldberg RJ
        A 30-year perspective (1975-2005) into the changing landscape of patients hospitalized with initial acute myocardial infarction: the Worcester Heart Attack Study.
        Circ Cardiovasc Qual Outcomes. 2009; 2: 88-95
        • McManus DD
        • Gore J
        • Yarzebski J
        • Spencer F
        • Lessard D
        • Goldberg RJ
        Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI.
        Am J Med. 2011; 124: 40-47
        • Jneid H
        • Anderson JL
        • Wright RS
        • Adams CD
        • Bridges CR
        • Casey Jr, DE
        • Ettinger SM
        • Fesmire FM
        • Ganiats TG
        • Lincoff AM
        • Peterson ED
        • Philippides GJ
        • Theroux P
        • Wenger NK
        • Zidar JP
        • Anderson JL
        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
        • O'Gara PT
        • Kushner FG
        • Ascheim DD
        • Casey Jr, DE
        • Chung MK
        • de Lemos JA
        • Ettinger SM
        • Fang JC
        • Fesmire FM
        • Franklin BA
        • Granger CB
        • Krumholz HM
        • Linderbaum JA
        • Morrow DA
        • Newby LK
        • Ornato JP
        • Ou N
        • Radford MJ
        • Tamis-Holland JE
        • Tommaso CL
        • Tracy CM
        • Woo YJ
        • Zhao DX
        • Anderson JL
        • Jacobs AK
        • Halperin JL
        • Albert NM
        • Brindis RG
        • Creager MA
        • DeMets D
        • Guyton RA
        • Hochman JS
        • Kovacs RJ
        • Kushner FG
        • Ohman EM
        • Stevenson WG
        • Yancy CW
        • American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
        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: e78-140
        • Stucchi M
        • Cantoni S
        • Piccinelli E
        • Savonitto S
        • Morici N
        Anemia and acute coronary syndrome: current perspectives.
        Vasc Health Risk Manag. 2018; 14: 109-118
        • Goldberg RJ
        • Yarzebski J
        • Lessard D
        • Wu J
        • Gore JM
        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
        • Goldberg RJ
        • Spencer F
        • Gore JM
        • Lessard D
        • Yarzebski J
        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
        • McManus DD
        • Chinali M
        • Saczynski JS
        • Gore JM
        • Yarzebski J
        • Spencer FA
        • Lessard D
        • Goldberg RJ
        30-year trends in heart failure in patients hospitalized with acute myocardial infarction.
        Am J Cardiol. 2011; 107: 353-359
        • Saczynski JS
        • Spencer FA
        • Gore JM
        • Gurwitz JH
        • Yarzebski J
        • Lessard D
        • Goldberg RJ
        Twenty-year trends in the incidence of stroke complicating acute myocardial infarction: the Worcester Heart Attack Study.
        Arch Intern Med. 2008; 168: 2104-2110
        • Nikolsky E
        • Aymong ED
        • Halkin A
        • Grines CL
        • Cox DA
        • Garcia E
        • Mehran R
        • Tcheng JE
        • Griffin JJ
        • Guagliumi G
        • Stuckey T
        • Turco M
        • Cohen DA
        • Negoita M
        • Lansky AJ
        • Stone GW
        Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial.
        J Am Coll Cardiol. 2004; 44: 547-553
        • Anker SD
        • Voors A
        • Okonko D
        • Clark AL
        • James MK
        • von Haehling S
        • Kjekshus J
        • Ponikowski P
        • Dickstein K
        • OPTIMAAL Investigators
        Prevalence, incidence, and prognostic value of anemia in patients after an acute myocardial infarction: data from the OPTIMAAL trial.
        Eur Heart J. 2009; 30: 1331-1339
        • Auffret V
        • Leurent G
        • Gilard M
        • Hacot JP
        • Filippi E
        • Delaunay R
        • Rialan A
        • Rouault G
        • Druelles P
        • Castellant P
        • Coudert I
        • Boulanger B
        • Treuil J
        • Bot E
        • Bedossa M
        • Boulmier D
        • Le Guellec M
        • Donal E
        • Le Breton H
        Incidence, timing, predictors and impact of acute heart failure complicating ST-segment elevation myocardial infarction in patients treated by primary percutaneous coronary intervention.
        Int J Cardiol. 2016; 221: 433-442
        • Dunlay SM
        • Weston SA
        • Killian JM
        • Bell MR
        • Jaffe AS
        • Roger VL
        Thirty-day rehospitalizations after acute myocardial infarction: a cohort study.
        Ann Intern Med. 2012; 157: 11-18