title: Clinical and economic outcomes among elderly myocardial infarction survivors in the United States.
abstract: OBJECTIVE
  Longitudinal data are limited regarding outcomes and costs beyond 1 year after acute myocardial infarction (MI) among elderly (≥65 years old) US patients. This study examined long-term outcomes and healthcare costs among elderly MI survivors.
  
  
  METHODS
  Retrospective analysis of 2002-2009 Medicare healthcare claims (5% random sample). Patients were ≥65 years old and survived ≥1 year without recurrent MI after MI hospitalization. Mortality, incidence of hospitalizations for stroke, major bleeding, MI, a composite endpoint (death, MI, or stroke), and nonpharmacy healthcare costs were determined.
  
  
  RESULTS
  Eligible patients included 16 244 STEMI, 34 576 NSTEMI, and 3109 unspecified MI. NSTEMI and unspecified MI patients had significantly higher prevalence of comorbidities than STEMI patients, except for hypertension and dyslipidemia. MI incidence declined 36% over the follow-up (3.82/100 person-years [PY] to 2.45/100 PY). Mortality, stroke, and bleeding decreased until the third year of follow-up and then increased. NSTEMI and unspecified MI patients had a significantly higher incidence of death, MI, the composite, and bleeding than STEMI patients throughout follow-up. All-cause inpatient costs during follow-up were 2.6- and 1.9-fold higher than baseline for STEMI and NSTEMI, respectively; cardiovascular-related inpatient costs were 3.5- and 2.2-fold higher, respectively.
  
  
  CONCLUSIONS
  Risks of mortality and cardiovascular events remain high in a Medicare population surviving >1 year after a MI. Continuing healthcare costs are doubled over pre-MI levels up to 5 years after an MI. Secondary prevention measures beyond the acute post-MI period may be indicated to reduce risk and cost in this chronic disease phase.
authors: Evidera, Waltham, MA, USA.
authors: Erru
authors: E
authors: Yang
authors: Evidera, Waltham, MA, USA.
authors: Michael
authors: M
authors: Stokes
authors: AstraZeneca R&D, Molndal, Sweden.
authors: Saga
authors: S
authors: Johansson
authors: AstraZeneca R&D, Molndal, Sweden.
authors: Carl
authors: C
authors: Mellström
authors: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors: Elizabeth
authors: E
authors: Magnuson
authors: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors: David J
authors: DJ
authors: Cohen
authors: Evidera, Waltham, MA, USA.
authors: Phillip
authors: P
authors: Hunt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000191:economics / Q000401:mortality / Q000628:therapy; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D020521:Stroke / Q000191:economics / Q000401:mortality / Q000628:therapy; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Medicare; Statistics and numerical data: epidemiology; Statistics and numerical data: utilization; comorbidity; myocardial infarction; survival analysis