title: Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN).
abstract: BACKGROUND
  Monitoring trends in cardiovascular events can provide key insights into the effectiveness of prevention efforts. Leveraging data from electronic health records provides a unique opportunity to examine contemporary, community-based trends in acute myocardial infarction hospitalizations.
  
  
  METHODS
  We examined trends in hospitalized acute myocardial infarction incidence among adults aged ≥25 years in 13 US health plans in the Cardiovascular Research Network. The first hospitalization per member for acute myocardial infarction overall and for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction was identified by International Classification of Diseases, Ninth Revision, Clinical Modification primary discharge codes in each calendar year from 2000 through 2008. Age- and sex-adjusted incidence was calculated per 100,000 person-years using direct adjustment with 2000 US census data.
  
  
  RESULTS
  Between 2000 and 2008, we identified 125,435 acute myocardial infarction hospitalizations. Age- and sex-adjusted incidence rates (per 100,000 person-years) of acute myocardial infarction decreased an average 3.8%/y from 230.5 in 2000 to 168.6 in 2008. Incidence of ST-segment elevation myocardial infarction decreased 8.7%/y from 104.3 in 2000 to 51.7 in 2008, whereas incidence of non-ST-segment elevation myocardial infarction increased from 126.1 to 129.4 between 2000 and 2004 and then decreased thereafter to 116.8 in 2008. Age- and sex-specific incidence rates generally reflected similar patterns, with relatively larger decreases in ST-segment elevation myocardial infarction rates in women compared with men. As compared with 2000, the age-adjusted incidence of ST-segment elevation myocardial infarction in 2008 was 48% lower among men and 61% lower among women.
  
  
  CONCLUSIONS
  Among a large, diverse, multicenter community-based insured population, there were significant decreases in incidence of hospitalized acute myocardial infarction and the more serious ST-segment elevation myocardial infarctions between 2000 and 2008. Decreases in ST-segment elevation myocardial infarctions were most pronounced among women. While ecologic in nature, these secular decreases likely reflect, at least in part, results of improvement in primary prevention efforts.
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, Calif. Electronic address: Kristi.Reynolds@kp.org.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, Calif; Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, Calif; Department of Health Research and Policy, Stanford University School of Medicine, Calif.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Leong
authors.affiliation: Group Health Research Institute, Seattle, Wash.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Boudreau
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Cassidy-Bushrow
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Ore.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fortmann
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Pa.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Meyers Primary Care Institute, A Joint Endeavor of Fallon Health, Reliant Medical Group, and University of Massachusetts Medical School, Worcester, Pa.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Colorado Permanente Medical Group, Denver; Colorado School of Public Health, University of Colorado Denver, Aurora; Colorado Cardiovascular Outcomes Research Consortium, Denver.
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minn.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Health, Temple, Tex.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: McNeal
authors.affiliation: Group Health Research Institute, Seattle, Wash.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newton
authors.affiliation: Human Nutrition, Food and Animal Science Department, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Novotny
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Ore.
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.affiliation: Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Wis.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: VanWormer
authors.affiliation: Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Md.
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.affiliation: Division of Research, Essentia Institute of Rural Health, Duluth, Minn.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Waring
authors.affiliation: Genomic Medicine Institute, Geisinger Health System, Danville, Pa.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Williams
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D000072658:Non-ST Elevated Myocardial Infarction / Q000453:epidemiology; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
keywords: Acute myocardial infarction; Cardiovascular disease; Epidemiology; Sex differences; Trends