title: National trends in heart failure hospitalization after acute myocardial infarction for Medicare beneficiaries: 1998-2010.
abstract: BACKGROUND
  Previous studies have reported conflicting findings regarding how the incidence of heart failure (HF) after acute myocardial infarction (AMI) has changed over time, and data on contemporary national trends are sparse.
  
  
  RESULTS
  Using a complete national sample of 2 789 943 AMI hospitalizations of Medicare fee-for-service beneficiaries from 1998 through 2010, we evaluated annual changes in the incidence of subsequent HF hospitalization and mortality using Poisson and survival analysis models. The number of patients hospitalized for HF within 1 year after AMI declined modestly from 16.1 per 100 person-years in 1998 to 14.2 per 100 person years in 2010 (P<0.001). After adjusting for demographic factors, a relative 14.6% decline for HF hospitalizations after AMI was observed over the study period (incidence risk ratio, 0.854; 95% confidence interval, 0.809-0.901). Unadjusted 1-year mortality following HF hospitalization after AMI was 44.4% in 1998, which decreased to 43.2% in 2004 to 2005, but then increased to 45.5% by 2010. After adjusting for demographic factors and clinical comorbidities, this represented a 2.4% relative annual decline (hazard ratio, 0.976; 95% confidence interval, 0.974-0.978) from 1998 to 2007, but a 5.1% relative annual increase from 2007 to 2010 (hazard ratio, 1.051; 95% confidence interval, 1.039-1.064).
  
  
  CONCLUSIONS
  In a national sample of Medicare beneficiaries, HF hospitalization after AMI decreased from 1998 to 2010, which may indicate improvements in the management of AMI. In contrast, survival after HF following AMI remains poor, and has worsened from 2007 to 2010, demonstrating that challenges still remain for the treatment of this high-risk condition after AMI.
authors.affiliation: From Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD (J.C.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (A.F.-C.H., K.D., H.M.K.); Division of Cardiology, Columbia University Medical Center, New York, NY (K.D.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and the Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and the Department of Health Policy Management, Yale School of Public Health, New Haven, CT (H.M.K.).
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Angela Fu-Chi
authors.initials: AF
authors.lastname: Hsieh
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data* / Q000639:trends*; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: epidemiology; heart failure; mortality; myocardial infarction