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Burden of Coronary Heart Disease Rehospitalizations Following Acute Myocardial Infarction in Older Adults

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Abstract

Purpose

Studies of prognosis following acute myocardial infarction (AMI) conventionally examine the first recurrent coronary heart disease (CHD) event which may not adequately characterize the full burden of CHD hospitalizations. We therefore examined the cumulative number of CHD rehospitalizations following AMI among older adults in the United States.

Methods

We conducted a retrospective cohort study of 78,085 Medicare beneficiaries aged ≥66 years without recent CHD history who were hospitalized for AMI in 2000–2010. Counts of CHD rehospitalizations over a maximum of 10 years of follow-up were calculated. Characteristics were assessed through claims and enrollment information and associations with CHD rehospitalizations were evaluated using Poisson models.

Results

Over 25 % of beneficiaries were aged ≥85 years, 55 % were women, and 89 % were white. Comorbidities were common, including diabetes (22.9 %), hypertension (46.7 %), heart failure (10.3 %), and chronic obstructive pulmonary disease (19.2 %). Following AMI, 16,078 beneficiaries (20.6 %) were hospitalized for CHD a total of 23,132 times. Among those who experienced at least one CHD rehospitalization, 35.9 % had ≥2 CHD rehospitalizations (n = 5773, 7.4 % of all beneficiaries with AMI) in the ensuing decade. Associations of demographics, comorbidities, and index hospitalization characteristics with rates of first and total CHD rehospitalizations were largely similar. Age ≥85 years versus 66–69 years was more strongly associated with first (rate ratio [RR] 1.43) than total (RR 1.35) CHD rehospitalization (p < 0.05), as was male versus female sex (RR 1.13 and 1.07).

Conclusions

Emphasizing the first recurrent CHD rehospitalization underestimates the burden of disease experienced among older adults with AMI.

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Author information

Author notes

  1. Monika M. Safford

    Present address: Weill Cornell Medical College, New York, NY, USA

  2. Ryan Kilpatrick

    Present address: Baxalta US, Inc, Cambridge, MA, USA

Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA

    Emily B. Levitan, Paul Muntner, Ligong Chen & Luqin Deng

  2. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA

    Meredith L. Kilgore & David Becker

  3. Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Stephen P. Glasser & Monika M. Safford

  4. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    George Howard

  5. Amgen Inc, Thousand Oaks, CA, USA

    Ryan Kilpatrick

  6. Cardiometabolics Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Robert S. Rosenson

Authors
  1. Emily B. Levitan
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  2. Paul Muntner
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  3. Ligong Chen
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  4. Luqin Deng
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  5. Meredith L. Kilgore
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  6. David Becker
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  8. Monika M. Safford
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Corresponding author

Correspondence to Emily B. Levitan.

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Funding Sources

This research, including design and conduct of the study, analysis and interpretation of the data, and preparation of the manuscript, was supported through an academic collaboration between University of Alabama at Birmingham, Icahn School of Medicine at Mount Sinai and Amgen Inc. The funders provided comments on the design and interpretation of this work. The academic authors conducted all analyses and maintained the rights to publish this manuscript.

Conflict of Interest

EBL, PM, LC, LD, MLK, DB, SPG, MMS, GH, and RSR report research support from Amgen Inc. EBL reports consulting for Amgen and Robinson Calcagnie Robinson Shapiro Davis. RK reports employment by Amgen Inc and Baxter BioScience.

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Levitan, E.B., Muntner, P., Chen, L. et al. Burden of Coronary Heart Disease Rehospitalizations Following Acute Myocardial Infarction in Older Adults. Cardiovasc Drugs Ther 30, 323–331 (2016). https://doi.org/10.1007/s10557-016-6653-6

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  • DOI: https://doi.org/10.1007/s10557-016-6653-6

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