title: Trends in mortality and recurrent coronary heart disease events after an acute myocardial infarction among Medicare beneficiaries, 2001-2009.
abstract: BACKGROUND
  Few contemporary studies examine trends in recurrent coronary heart disease (CHD) events and mortality after acute myocardial infarction (AMI) and whether these trends vary by race or sex.
  
  
  METHODS
  We used data from the national 5% random sample of Medicare fee-for-service beneficiaries for 1999 to 2010. We included beneficiaries who experienced an AMI (International Classification of Disease [ICD] 9 410.xx, except 410.x2) between January 1, 2001, and December 31, 2009. Each beneficiary's first AMI was included as their index event. Outcomes included all-cause mortality, recurrent AMI, and recurrent CHD events during the 365days after discharge for the index AMI. To examine secular trends, we pooled calendar years into 3 periods (2001-2003, 2004-2006, and 2007-2009).
  
  
  RESULTS
  Among 48,688 beneficiaries with index AMIs from 2001 to 2009, we observed decreases in the age-adjusted rates for mortality (-3.8% for each 3-year period, 95% CI -6.1% to -1.6%, P trend = .001), recurrent AMI (-15.0%, 95% CI -18.6% to -11.2%, P trend < .001), and recurrent CHD events (-11.1%, 95% CI -14.0% to -8.0%, P trend < .001) in the 365days after the index AMI. In 2007 to 2009, blacks had excess risk relative to whites for mortality and recurrent AMI (black/white incidence rate ratio of 1.38 for mortality [95% CI 1.21-1.57] and 1.38 for recurrent AMI [95% CI 1.07-1.79]).
  
  
  CONCLUSIONS
  Despite overall favorable trends in lower mortality and recurrent events after AMI, efforts are needed to reduce racial disparities.
authors: School of Medicine, University of Alabama at Birmingham, Birmingham, AL. Electronic address: tmbrown@uab.edu.
authors: Todd M
authors: TM
authors: Brown
authors: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors: Luqin
authors: L
authors: Deng
authors: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors: David J
authors: DJ
authors: Becker
authors: School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors: Vera
authors: V
authors: Bittner
authors: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors: Emily B
authors: EB
authors: Levitan
authors: Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Robert S
authors: RS
authors: Rosenson
authors: School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors: Monika M
authors: MM
authors: Safford
authors: School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors: Paul
authors: P
authors: Muntner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000208:ethnology / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D044469:Racial Groups; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology