First-time MI hospitalizations decreased in Denmark over past 25 years
MedWire News: The rate of first-time hospitalization for myocardial infarction (MI) and subsequent mortality decreased by nearly half between 1984 and 2008 in Denmark, a study shows.
This finding is likely attributable to lifestyle changes, risk factor modification, and increased use of "aggressive medical and interventional treatment" in line with international recommendations, write Morten Schmidt (Aaarhus University Hospital, Denmark) and colleagues.
They examined the standardized incidence rate of MI and 30-day and 31-365-day mortality among 234,331 patients who had a first-time hospitalization in Denmark from 1984 through 2008.
Comorbidity was classified according to the modified Charlson comorbidity index as used in the Predicting Risk of Death in Cardiac Disease Tool (PREDICT) study as normal (0 points), moderate (1), severe (2), and very severe (≥3).
As reported in the British Medical Journal, the standardized incidence rate of MI per 100,000 people decreased by 37% for women, from 209 to 131 cases per 100,000; and by 48% for men, from 410 to 213 per 100,000; over the 25-year period.
The 30-day, 31 to 365-day, and 1-year mortality declined from 31.4%, 15.6%, and 42.1% through 1984-1988 to 14.8%, 11.1%, and 24.2% through 2004-2008, respectively.
Age-stratified analysis showed no significant difference in 1-year mortality between men and women.
After adjusting for age and gender, the 30-day mortality rate ratio for patients with very severe comorbidity compared with those who had normal comorbidity during 2004-2008 was 1.96, and for 31-365-day mortality was 3.89.
These results imply that comorbidity was a strong prognostic factor for short- and long-term mortality, while gender was not, write the authors.
They say that their findings have implications for research and clinical care, suggesting that future clinical trials should include patients who have prevalent comorbid illness, so that results can be extrapolated to the entire spectrum of patients with MI.
In terms of clinical care, comorbidity should be considered as part of individual patient counseling, with treatment optimized to improve the outcome of both the comorbid condition and MI, add Schmidt and team.
"Our findings are particularly important for elderly people, given their high prevalence of comorbidity and the increasing numbers of people of advanced age facing treatment decisions for coronary artery disease."
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By Piriya Mahendra