Clinical research study
Acute Myocardial Infarction Hospitalization in the United States, 1979 to 2005

https://doi.org/10.1016/j.amjmed.2009.08.018Get rights and content

Abstract

Background

We reported earlier that there was no decline of acute myocardial infarction hospitalization from 1988 to 1997. We now extend these observations to document trends in acute myocardial infarction hospitalization rates and in-hospital case-fatality rates for 27 years from 1979 to 2005.

Methods

We determined hospitalization rates for acute myocardial infarction 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. We also assessed comorbid, complications, cardiac procedure use, and in-hospital case-fatality rates.

Results

Age-adjusted hospitalization rate for acute myocardial infarction 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 aged 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. Acute myocardial infarction complicated by heart failure increased, and cardiogenic shock decreased. Altogether, the in-hospital case-fatality rate declined.

Conclusion

During the past quarter century, hospitalization for acute myocardial infarction increased until the mid-1990s, but has declined since then. At the same time, in-hospital case-fatality rates declined steadily. This decline has been associated with more aggressive therapeutic intervention.

Section snippets

Data Sources

The National Hospital Discharge Survey (NHDS) 1979-2005 was conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. The NHDS collected annual data from a sample of inpatient records acquired from a national sample of hospitals. General hospitals or children's general hospitals, and hospitals with an average length of stay of fewer than 30 days for all patients were included in the survey. Federal, military, and Department of Veterans Affairs hospitals

Results

The total number of hospitalizations with the first-listed diagnosis of acute myocardial infarction was approximately 432,000 in 1979 and 681,000 in 2005, a 58% increase. Hospitalization rates were 194 and 231 per 100,000 population for 1979 and 2003, respectively. The mean (± standard deviation) age of patients was 67 ± 14 years (60% were aged  65 years), and 60% were men. Among acute myocardial infarction hospitalizations, women were older than men (71 ± 13 years vs 64 ± 13 years).

Discussion

From 1979 to 2005, acute myocardial infarction hospitalization rates increased from 194 to 231. These rates increased at first, then leveled off, and finally declined slowly. During this time, there were increases in use of cardiac catheterization, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, and thrombolytic drugs. Length of stay decreased substantially during this time, as did in-hospital case-fatality rates. In addition, disparities were noted by age

Conclusions

During the past quarter century, although coronary heart disease mortality has decreased, hospitalization for acute myocardial infarction 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 associated with both shorter length of stay and decreasing in-hospital case-fatality rates.

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    Funding: None.

    Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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