title: Outcomes following acute hospitalised myocardial infarction in France: An insurance claims database analysis.
abstract: BACKGROUND
  Mortality and complications of acute myocardial infarction (AMI) in France have declined over the last twenty years, but still remain high. Practice guidelines recommend secondary prevention measures to reduce these. Insurance claims databases can be used to assess the management of post MI and other cardiovascular outcomes in everyday practice.
  
  
  METHODS
  A cohort study was performed in a 1/97 representative sample of the French nationwide claims and hospitalisation database (EGB database). All adults with a documented hospitalisation for MI between 2007 and 2011 were included, and followed for three years. Data was extracted on demographics, the index admission, reimbursed medication, comorbidities, post-MI events and death.
  
  
  RESULTS
  During the study period, 1977 individuals hospitalised for an MI were identified, with a mean (±SD) age of 63.8 (±14.3) years, 65.8% were men, 82.4% had hypertension and 37.6% hypercholesterolaemia. The mean duration of hospitalisation was seven days and 8.3% of patients died during hospitalisation. After discharge, the majority of patients received secondary prevention with statins (92.2%), anti-platelet drugs (95.6%), beta-blockers (86.0%) and angiotensin converting enzyme inhibitors (71.4%). After three years of follow-up post-discharge, cumulative mortality was 20.5% [18.4%;22.5%] and the cumulative incidence of reinfarction and stroke/TIA were 4.7% [95% CI: 3.7%;5.7%] and 4.1% [3.1%;5.0%], respectively.
  
  
  CONCLUSIONS
  Despite high use of secondary prevention at discharge, mortality and incidence of serious cardiovascular events following MI remain high. This underscores the need to improve secondary prevention.
authors.affiliation: Bordeaux PharmacoEpi, CIC Bordeaux CIC 1401, Service de Pharmacologie Médicale, Université Bordeaux, Bordeaux, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Blin
authors.affiliation: Département de Pathologie Cardiaque, Institut Mutualiste Montsouris, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Philippe
authors.affiliation: CEMKA-EVAL, Bourg-la-Reine, France. Electronic address: Stephane.bouee@cemka.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bouée
authors.affiliation: CEMKA-EVAL, Bourg-la-Reine, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Laurendeau
authors.affiliation: Département de Pathologie Cardiaque, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Torreton
authors.affiliation: INSERM UMS 011, Villejuif, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Gourmelin
authors.affiliation: Merck Sharpe &Dohme, Courbevoie, France.
authors.forename: Sandy
authors.initials: S
authors.lastname: Leproust
authors.affiliation: Merck Sharpe &Dohme, Courbevoie, France.
authors.forename: Laurie
authors.initials: L
authors.lastname: Levy-Bachelot
authors.affiliation: Université Paris Diderot, Sorbonne-Paris Cité, and INSERM U-1148, Paris, France; FACT, an F-CRIN network, DHU FIRE, Département de Cardiologie, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007345:Insurance Claim Review / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D055502:Secondary Prevention / Q000379:methods / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cost; Death; France; Myocardial infarction; Recurrence; Treatment