TY - JOUR
T1 - Trends, management, and outcomes of acute myocardial infarction hospitalizations with in-hospital-onset versus out-of-hospital onset
T2 - The aric study
AU - Caughey, Melissa C.
AU - Arora, Sameer
AU - Qamar, Arman
AU - Chunawala, Zainali
AU - Gupta, Mohit D.
AU - Gupta, Puneet
AU - Vaduganathan, Muthiah
AU - Pandey, Ambarish
AU - Dai, Xuming
AU - Smith, Sidney C.
AU - Matsushita, Kunihiro
N1 - Funding Information:
Dr Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/National Center for Advancing Translational Sciences (NCATS) Award UL 1TR002541) and serves on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, Cytokinetics, and Relypsa. Dr Qamar is supported by institutional grant support from the NorthShore Auxiliary research scholar fund and has received funding from Daiichi-Sankyo, American Heart Association and fees for educational activities from the American College of Cardiology, Society for Vascular Medicine, Society for Cardiovascular Angiography and Interventions, Janssen and Janssen, Pfizer, Medscape, and Clinical Exercise Physiology Association. The remaining authors have no disclosures to report.
Funding Information:
The ARIC study was funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I.
Publisher Copyright:
© 2020 The Authors.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Acute myocardial infarction (AMI) with in-hospital onset (AMI-IHO) has poor prognosis but is clinically underap-preciated. Whether its occurrence has changed over time is uncertain. METHODS AND RESULTS: Since 1987, the ARIC (Atherosclerosis Risk in Communities) study has conducted adjudicated surveillance of AMI hospitalizations in 4 US communities. Our analysis was limited to patients aged 35 to 74 years with symptomatic AMI. Patients with symptoms initiating after hospital arrival were considered AMI-IHO. A total of 26 678 weighted hospitalizations (14 276 unweighted hospitalizations) for symptomatic AMI were identified from 1995 to 2014, with 1137 (4%) classified as in-hospital onset. The population incidence rate of AMI-IHO increased in the 4 ARIC communities from 1995 through 2004 to 2005 through 2014 (12.7—16.9 events per 100 000 people; P for 20-year trend <0.0001), as did the proportion of AMI hospitalizations with in-hospital onset (3.7%–6.1%; P for 20-year trend =0.03). The 10-year proportions were stable for patients aged 35 to 64 years (3.0%–3.4%; P for 20-year trend =0.3) but increased for patients aged ≥65 years (4.6%–7.8%; P for 20-year trend =0.008; P for interaction by age group =0.04). AMI-IHO had a more severe clinical course with lower use of AMI therapies or invasive strategies and higher in-hospital (7% versus 3%), 28-day (19% versus 5%), and 1-year (29% versus 12%) mortality (P<0.0001 for all). CONCLUSIONS: In this population-based community surveillance, AMI-IHO increased from 2005 to 2014, particularly among older patients. Quality initiatives to improve recognition and management of AMI-IHO should be especially focused on hospitalized patients aged >65.
AB - BACKGROUND: Acute myocardial infarction (AMI) with in-hospital onset (AMI-IHO) has poor prognosis but is clinically underap-preciated. Whether its occurrence has changed over time is uncertain. METHODS AND RESULTS: Since 1987, the ARIC (Atherosclerosis Risk in Communities) study has conducted adjudicated surveillance of AMI hospitalizations in 4 US communities. Our analysis was limited to patients aged 35 to 74 years with symptomatic AMI. Patients with symptoms initiating after hospital arrival were considered AMI-IHO. A total of 26 678 weighted hospitalizations (14 276 unweighted hospitalizations) for symptomatic AMI were identified from 1995 to 2014, with 1137 (4%) classified as in-hospital onset. The population incidence rate of AMI-IHO increased in the 4 ARIC communities from 1995 through 2004 to 2005 through 2014 (12.7—16.9 events per 100 000 people; P for 20-year trend <0.0001), as did the proportion of AMI hospitalizations with in-hospital onset (3.7%–6.1%; P for 20-year trend =0.03). The 10-year proportions were stable for patients aged 35 to 64 years (3.0%–3.4%; P for 20-year trend =0.3) but increased for patients aged ≥65 years (4.6%–7.8%; P for 20-year trend =0.008; P for interaction by age group =0.04). AMI-IHO had a more severe clinical course with lower use of AMI therapies or invasive strategies and higher in-hospital (7% versus 3%), 28-day (19% versus 5%), and 1-year (29% versus 12%) mortality (P<0.0001 for all). CONCLUSIONS: In this population-based community surveillance, AMI-IHO increased from 2005 to 2014, particularly among older patients. Quality initiatives to improve recognition and management of AMI-IHO should be especially focused on hospitalized patients aged >65.
KW - Acute myocardial infarction
KW - Inpatient onset
KW - Outcomes
KW - Surveillance
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U2 - 10.1161/JAHA.120.018414
DO - 10.1161/JAHA.120.018414
M3 - Article
C2 - 33399008
AN - SCOPUS:85099829699
SN - 2047-9980
VL - 10
SP - 1
EP - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e018414
ER -