Changing trends in the long-term prognosis of patients with acute myocardial infarction: a population-based perspective.
BACKGROUND
Little contemporary data exist describing changes over time in the postdischarge prognosis of hospital survivors of acute myocardial infarction (AMI). The purpose of our study was to examine recent and multidecade-long (1975-2001) trends in the long-term prognosis of greater Worcester (MA) residents discharged from all metropolitan Worcester hospitals after confirmed AMI.


METHODS
A total of 9827 greater Worcester residents with independently validated AMI discharged from all metropolitan Worcester hospitals during 13 annual periods between 1975 and 2001 comprised the study population. A variety of follow-up approaches were used to ascertain the survival status of discharged patients through the end of 2003.


RESULTS
Crude unadjusted 1-year postdischarge survival rates declined over time. Suggestions of modest improvements in the multivariable adjusted 1-year postdischarge survival rates were noted, however, in patients discharged from greater Worcester hospitals in the more recent (2001) (adjusted odds of surviving 1.23, 95% CI 0.97-1.55) as compared with earliest study periods (1975/1978). Advancing age, female sex, presence of prior diabetes, stroke, heart failure, or myocardial infarction and occurrence of several clinical complications during hospitalization were significantly related to an adverse postdischarge prognosis.


CONCLUSIONS
The results of this investigation provide contemporary insights into the long-term survival of patients with AMI from a more generalizable population-based perspective. Multivariable adjusted analyses revealed slight improvements in postdischarge survival over time. Our data identify several high-risk groups that should be targeted for more aggressive surveillance and increased use of effective cardiac therapies and interventions.
Botkin
Naomi F
NF
Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Spencer
Frederick A
FA
Goldberg
Robert J
RJ
Lessard
Darleen
D
Yarzebski
Jorge
J
Gore
Joel M
JM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors