title: Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001-2011.
abstract: BACKGROUND
  Little is known whether time trends of in-hospital mortality and costs of care for acute myocardial infarction (AMI) differ by type of AMI (ST-elevation myocardial infarction [STEMI] vs. non-ST-elevation [NSTEMI]) and by the intervention received (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], or no intervention) in the United States.
  
  
  RESULTS
  We conducted a serial cross-sectional study of all hospitalizations for AMI aged 30 years or older using the Nationwide Inpatient Sample, 2001-2011 (1,456,154 discharges; a weighted estimate of 7,135,592 discharges). Hospitalizations were stratified by type of AMI and intervention, and the time trends of in-hospital mortality and hospital costs were examined for each combination of the AMI type and intervention, after adjusting for both patient- and hospital-level characteristics. Compared with 2001, adjusted in-hospital mortality improved significantly for NSTEMI patients in 2011, regardless of the intervention received (PCI odds ratio [OR] 0.68, 95% CI 0.56 to 0.83; CABG OR 0.57, 0.45 to 0.72; without intervention OR 0.61, 0.57 to 0.65). As for STEMI, a decline in adjusted in-hospital mortality was significant for those who underwent PCI (OR 0.83; 0.73 to 0.94); however, no significant improvement was observed for those who received CABG or without intervention. Hospital costs per hospitalization increased significantly for patients who underwent intervention, but not for those without intervention.
  
  
  CONCLUSIONS
  In the United States, the decrease in in-hospital mortality and the increase in costs differed by the AMI type and the intervention received. These non-uniform trends may be informative for designing effective health policies to reduce the health and economic burdens of AMI.
authors: Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan (T.S.) Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan (T.S., Y.K.).
authors: Takehiro
authors: T
authors: Sugiyama
authors: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.H.).
authors: Kohei
authors: K
authors: Hasegawa
authors: Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan (T.S., Y.K.).
authors: Yasuki
authors: Y
authors: Kobayashi
authors: Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan (O.T., T.F.).
authors: Osamu
authors: O
authors: Takahashi
authors: Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan (O.T., T.F.).
authors: Tsuguya
authors: T
authors: Fukui
authors: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Y.T.) Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.).
authors: Yusuke
authors: Y
authors: Tsugawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000191:economics / Q000639:trends; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000191:economics* / Q000639:trends*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000639:trends; D017064:Process Assessment, Health Care / Q000191:economics* / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: acute myocardial infarction; hospital costs; in‐hospital mortality; time trend