Acute myocardial infarction in Alberta: temporal changes in outcomes, 1994 to 1999.
BACKGROUND
The current survival trends in patients with acute myocardial infarction (AMI) are not known. A population-based study using administrative data to examine the short and long term survival of patients after AMI in Alberta between 1994 and 1999 was conducted.


METHODS
AMI patients were identified from hospital discharge data. Temporal changes in the adjusted (age, sex, AMI anatomical location and comorbidities) fatality rate were analyzed in 19,928 AMI patients.


RESULTS
The age- and sex-adjusted incidence of hospitalization for AMI in Alberta significantly declined from 169.6 per 100,000 population in 1994 to 160.8 per 100,000 in 1999 (P=0.03). The risk-adjusted in-hospital case fatality rate from all causes was 11.4% (95% CI 10.6% to 12.3%) in 1994 versus 9.2% (8.4% to 10.1%) in 1999; the 30-day case fatality rate was 12.6% (11.7% to 13.6%) in 1994 versus 10.1% (9.1% to 11.0%) in 1999; and the one-year case fatality rate was 19.0% (17.8% to 20.1%) in 1994 versus 14.9% (13.8% to 16.0%) in 1999. The percentage of hospitalized AMI patients who underwent coronary angiography within one year after admission rose from 48.2% in 1994 to 52.4% in 1999; percutaneous transluminal coronary angioplasty increased from 25.5% to 35.0% and coronary artery bypass surgery increased from 9.7% to 12.6%. Prescriptions for pharmacological drugs at discharge increased from 1994 to 1999 among patients aged 65 and older: from 29.5% in 1994 to 41.0% in 1999 for beta-blockers, from 5.2% to 18.7% for lipid lowering agents and from 14.0% to 20.5% for angiotensin-converting enzyme inhibitors.


CONCLUSIONS
There was a modest improvement in patient survival after AMI between 1994 and 1999. The improvements may be associated with increasing use of revascularization and pharmacological therapy provided in the management of AMI.
Quan
Hude
H
Department of Community Health Sciences, Centre for Health and Policy Studies, University of Calgary, Quality Improvement and Health Information, Calgary Health Region, Alberta. hquan@ucalgary.ca
Cujec
Bibiana
B
Jin
Yan
Y
Johnson
David
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D010359:Patient Readmission; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors