title: Temporal Trends in Treatment and Outcomes of Acute Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Observational Study.
abstract: BACKGROUND
  Acute myocardial infarction is a major cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD); however, temporal trends in the management and clinical outcomes of these patients remain unclear.
  
  
  RESULTS
  We conducted an observational study by using a representative sample of 1 million beneficiaries from the Taiwan National Health Insurance Research Database. Comorbidities, in-hospital treatment, and outcomes were compared for patients with acute myocardial infarction with and without COPD between 2004 and 2013. Temporal trends in treatment and outcomes were analyzed. We included 6770 patients admitted to hospitals with acute myocardial infarction diagnoses, of whom 1921 (28.3%) had COPD. Fewer patients with COPD received β-blockers (adjusted odds ratio 0.66, 95% CI 0.59-0.74), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (adjusted odds ratio 0.83, 95% CI 0.73-0.93), statins, anticoagulants, dual antiplatelets, and coronary interventions. These patients had higher mortality (in hospital: adjusted hazard ratio 1.25 [95% CI 1.11-1.41]; 1 year: adjusted hazard ratio 1.20 [95% CI 1.09-1.32]) and respiratory failure risk during admission. Temporal trends showed little improvement in mortality in patients with COPD over 10 years. Multivariable logistic regression indicated that dual antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins, coronary angiography, and coronary artery bypass grafting surgery were significantly correlated with improved mortality in patients with COPD.
  
  
  CONCLUSIONS
  In Taiwan, a lower proportion of patients with COPD received evidence-based therapies for acute myocardial infarction than did patients without COPD, and their clinical outcomes were inferior. Limited improvement in mortality was observed over the preceding 10 years and is attributable to the underuse of evidence-based treatments.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Tse-Hsuan
authors.initials: TH
authors.lastname: Su
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Shang-Hung
authors.initials: SH
authors.lastname: Chang
authors.affiliation: Department of Public Health, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan ylchan@cgmh.org.tw.
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Chan
mesh_terms: D000368:Aged; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000639:trends*; D011159:Population Surveillance; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology
keywords: acute myocardial infarction; chronic obstructive pulmonary disease; mortality; temporal trends; β‐blockers