title: National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010.
abstract: BACKGROUND
  Stroke is a common and important adverse event after acute myocardial infarction (AMI) in the elderly. It is unclear whether the risk of stroke after AMI has changed with improvements in treatments and outcomes for AMI in the last decade.
  
  
  METHODS
  To assess trends in risk of stroke after AMI, we used a national sample of Medicare data to identify Fee-for-Service patients (n = 2,305,441) aged ≥65 years who were discharged alive after hospitalization for AMI from 1999 to 2010.
  
  
  RESULTS
  We identified 57,848 subsequent hospitalizations for ischemic stroke and 4,412 hospitalizations for hemorrhagic stroke within 1 year after AMI. The 1-year rate of ischemic stroke decreased from 3.4% (95% CI 3.3%-3.4%) to 2.6% (2.5%-2.7%; P < .001). The risk-adjusted annual decline was 3% (hazard ratio, 0.97; [0.97-0.98]) and was similar across all age and sex-race groups. The rate of hemorrhagic stroke remained stable at 0.2% and did not differ by subgroups. The 30-day mortality for patients admitted with ischemic stroke after AMI decreased from 19.9% (18.8%-20.9%) to 18.3% (17.1%-19.6%) and from 48.3% (43.0%-53.6%) to 45.7% (40.3%-51.2%) for those admitted with hemorrhagic stroke. We observed a decrease in 1-year mortality from 37.8% (36.5%-39.1%) to 35.3% (33.8%-36.8%) for ischemic stroke and from 66.6% (61.4%-71.5%) to 60.6% (55.1%-65.9%) for hemorrhagic stroke.
  
  
  CONCLUSIONS
  From 1999 to 2010, the 1-year risk for ischemic stroke after AMI declined, whereas the risk of hemorrhagic stroke remained unchanged. However, 30-day and 1-year mortality continued to be high.
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Department of Biostatistics, Harvard School of Public Health, Boston, MA.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; (During the time the work was conducted) Division of Cardiology, Columbia University Medical Center, New York, NY.
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.affiliation: University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: (During the time the work was conducted) Division of Aging, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD.
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.affiliation: St Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.affiliation: Ann Arbor VA Center for Clinical Management and Research and University of Michigan Health System, Ann Arbor, MI.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Electronic address: harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D014481:United States