title: Recent trends in post-discharge mortality among patients with an initial acute myocardial infarction.
abstract: The objectives of this study were to describe contemporary postdischarge death rates of patients hospitalized at all Worcester, Massachusetts, hospitals after initial acute myocardial infarctions (AMIs) and to examine factors associated with a poor prognosis. The medical records of patients discharged from 11 central Massachusetts medical centers after initial AMIs during 2001, 2003, 2005, and 2007 were reviewed, identifying 2,452 patients. This population was composed of predominantly older patients, men (58%), and whites. Overall, the 3-month, 1-year, and 2-year all-cause death rates were 8.9%, 16.4%, and 23.4%, respectively. Over time, reductions in postdischarge mortality were observed in crude as well as multivariate-adjusted analyses. In 2001, the 3-month, 1-year, and 2-year all-cause death rates were 11.1%, 17.1%, and 25.6%, respectively, compared to rates of 7.9%, 12.7%, and 18.6% in patients discharged in 2007. Older age, male gender, hospitalization for a non-ST-segment elevation AMI, renal dysfunction, and preexisting heart failure were associated with an increased risk for dying after hospital discharge. These results suggest that the postdischarge prognosis of patients with initial AMIs has improved, likely reflecting enhanced in-hospital and postdischarge management practices. In conclusion, patients with initial AMIs can also be identified who are at increased risk for dying after hospital discharge, in whom increased surveillance and targeted treatment approaches can be directed.
authors: Program in Gene Function and Expression, University of Massachusetts Medical School, Worcester, USA.
authors: Andrew H
authors: AH
authors: Coles
authors: Kimberly A
authors: KA
authors: Fisher
authors: Chad
authors: C
authors: Darling
authors: David
authors: D
authors: McManus
authors: Oscar
authors: O
authors: Maitas
authors: Jorge
authors: J
authors: Yarzebski
authors: Joel M
authors: JM
authors: Gore
authors: Darleen
authors: D
authors: Lessard
authors: Robert J
authors: RJ
authors: Goldberg
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009026:Mortality / Q000639:trends*; D009203:Myocardial Infarction / Q000401:mortality*; D010351:Patient Discharge; D011379:Prognosis; D051437:Renal Insufficiency / Q000401:mortality; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis