title: Burden of Coronary Heart Disease Rehospitalizations Following Acute Myocardial Infarction in Older Adults.
abstract: OBJECTIVE
  Studies of prognosis following acute myocardial infarction (AMI) conventionally examine the first recurrent coronary heart disease (CHD) event which may not adequately characterize the full burden of CHD hospitalizations. We therefore examined the cumulative number of CHD rehospitalizations following AMI among older adults in the United States.
  
  
  METHODS
  We conducted a retrospective cohort study of 78,085 Medicare beneficiaries aged ≥66 years without recent CHD history who were hospitalized for AMI in 2000-2010. Counts of CHD rehospitalizations over a maximum of 10 years of follow-up were calculated. Characteristics were assessed through claims and enrollment information and associations with CHD rehospitalizations were evaluated using Poisson models.
  
  
  RESULTS
  Over 25 % of beneficiaries were aged ≥85 years, 55 % were women, and 89 % were white. Comorbidities were common, including diabetes (22.9 %), hypertension (46.7 %), heart failure (10.3 %), and chronic obstructive pulmonary disease (19.2 %). Following AMI, 16,078 beneficiaries (20.6 %) were hospitalized for CHD a total of 23,132 times. Among those who experienced at least one CHD rehospitalization, 35.9 % had ≥2 CHD rehospitalizations (n = 5773, 7.4 % of all beneficiaries with AMI) in the ensuing decade. Associations of demographics, comorbidities, and index hospitalization characteristics with rates of first and total CHD rehospitalizations were largely similar. Age ≥85 years versus 66-69 years was more strongly associated with first (rate ratio [RR] 1.43) than total (RR 1.35) CHD rehospitalization (p < 0.05), as was male versus female sex (RR 1.13 and 1.07).
  
  
  CONCLUSIONS
  Emphasizing the first recurrent CHD rehospitalization underestimates the burden of disease experienced among older adults with AMI.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA. elevitan@uab.edu.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA.
authors.forename: Ligong
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA.
authors.forename: Luqin
authors.initials: L
authors.lastname: Deng
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Becker
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Glasser
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: Amgen Inc, Thousand Oaks, CA, USA.|Baxalta US, Inc, Cambridge, MA, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kilpatrick
authors.affiliation: Cardiometabolics Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rosenson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Coronary heart disease; Myocardial infarction; Recurrent hospitalization