title: National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
abstract: BACKGROUND
  There are few data characterizing temporal changes in hospitalization for recurrent acute myocardial infarction (AMI) after AMI.
  
  
  RESULTS
  Using a national sample of 2 305 441 Medicare beneficiaries hospitalized for AMI from 1999 to 2010, we evaluated changes in the incidence of 1-year recurrent AMI hospitalization and mortality using Cox proportional hazards models. The observed recurrent AMI hospitalization rate declined from 12.1% (95% CI 11.9 to 12.2) in 1999 to 8.9% (95% CI 8.8 to 9.1) in 2010, a relative decline of 26.4%. The observed recurrent AMI hospitalization rate declined by a relative 27.7% in whites, from 11.9% (95% CI 11.8 to 12.1) to 8.6% (95% CI 8.5 to 8.8) versus a relative decline in blacks of 13.6% from 13.2% (95% CI 12.6 to 13.8) to 11.4% (95% CI 10.9 to 12.0). The risk-adjusted rate of annual decline in recurrent AMI hospitalizations was 4.1% (HR 0.959; 95% CI 0.958 to 0.961), and whites experienced a higher rate of decline (HR 0.957, 95% CI 0.956 to 0.959) than blacks (HR 0.974, 95% CI 0.970 to 0.979).The overall, observed 1-year mortality rate after hospitalization for recurrent AMI declined from 32.4% in 1999 to 29.7% in 2010, a relative decline of 8.3% (P<0.05). In adjusted analyses, 1-year mortality after recurrent AMI hospitalization declined 1.8% per year (HR, 0.982; 95% CI 0.980 to 0.985).
  
  
  CONCLUSIONS
  In a national sample of Medicare beneficiaries hospitalized for AMI from 1999 to 2010, hospitalization for recurrent AMI decreased, as did subsequent mortality, albeit to a lesser extent. The risk of recurrent AMI hospitalization declined less in black patients than in whites, increasing observed racial disparities by the end of the study period.
authors.affiliation: Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.).
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.affiliation: Yale School of Medicine, New Haven, CT (R.F.K.).
authors.forename: Rabeea F
authors.initials: RF
authors.lastname: Khan
authors.affiliation: Kaiser Permanente Research Institute, Rockville, MD (J.C.).
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., H.M.K.) Division of Cardiology, Columbia University Medical Center, New York, NY (K.D.).
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (J.A.D.).
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.).
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.).
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.) Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.D., H.M.K.) Department of Health Policy Management, Yale School of Public Health, New Haven, CT (H.M.K.).
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014481:United States
keywords: epidemiology; mortality; myocardial infarction