Title: Acute Myocardial Infarction Hospitalization in the United States, 1979 to 2005
Topic: General Cardiology
Date Posted: 4/5/2010
Author(s): Fang J, Alderman MH, Keenan NL, Ayala C.
Citation: Am J Med 2010;123:259-266.
Clinical Trial: No
Study Question: What are the trends in acute myocardial infarction (AMI) hospitalization rates for 27 years, from 1979 to 2005?
Methods: The investigators determined hospitalization rates for AMI by age and gender using data from the National Hospital Discharge Survey and US civilian population from 1979 to 2005, aggregated by 3-year groupings. They also assessed comorbid, complications, cardiac procedure use, and in-hospital case-fatality rates.
Results: Age-adjusted hospitalization rate for AMI identified by primary International Classification of Diseases code was 215 per 100,000 people in 1979-1981 and increased to 342 in 1985-1987. Thereafter, the rate stabilized for the next decade and then declined slowly after 1996 to 242 in 2003-2005. Trends were similar for men and women, although rates for men were almost twice that of women. Hospitalization rates increased substantially with age and were the highest among those ages 85 years or more. Although median hospital stay decreased from 12 to 4 days, intensity of hospital care increased, including use of coronary angioplasty, coronary bypass, and thrombolytics therapy. During the period, reported comorbidity from diabetes and hypertension increased. AMI complicated by heart failure increased, and cardiogenic shock decreased. Altogether, the in-hospital case-fatality rate declined.
Conclusions: The authors concluded that during the past quarter century, hospitalization for AMI increased until the mid-1990s, but has declined since then.
Perspective: This analysis suggests that during the past quarter century, hospitalization for AMI has only begun to decline more recently. At the same time, there has been a trend toward more intensive acute care and vastly expanded use of invasive procedures. The changes in AMI observed can be attributed to multiple factors, including change in incidence rates and reduction in risk of death before hospitalization, changing diagnostic criteria of MI, hospital treatment, and data-collection methods. The use of more sensitive biomarkers has probably contributed significantly to the increased diagnosis of MI in recent years. It is reassuring that in-hospital case-fatality rates have declined steadily, but we need to continue to be vigilant about providing optimal secondary preventative therapies to patients presenting with an MI. Debabrata Mukherjee, M.D., F.A.C.C.
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