Chen Han-Yang, Gore Joel M, Lapane Kate L, Yarzebski Jorge, Person Sharina D, Gurwitz Jerry H, Kiefe Catarina I, Goldberg Robert J
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
Am J Cardiol. 2015 Jul 1;116(1):24-9. doi: 10.1016/j.amjcard.2015.03.035. Epub 2015 Apr 6.
There are limited population-based data available describing trends in the long-term prognosis of patients discharged from the hospital after an initial acute myocardial infarction (AMI). Our objectives were to describe multidecade trends in post-discharge mortality and their association with hospital management practices in patients discharged from all medical centers in Central Massachusetts after a first AMI. Residents of the Worcester, Massachusetts, metropolitan area discharged from all hospitals in Central Massachusetts after a first AMI from 1975 to 2009 comprised the study population (n = 8,728). Multivariable-adjusted logistic regression analyses were used to examine the association between year of hospitalization and 1-year post-discharge mortality. The average age of this population was 66 years, and 40% were women. Patients hospitalized in 1999 to 2009, compared with those discharged in 1975 to 1984, were older, more likely to be women, and have multiple previously diagnosed co-morbidities. Hospital use of invasive cardiac interventions and medications increased markedly over time. Unadjusted 1-year mortality rates were 12.9%, 12.5%, and 15.8% for patients discharged during 1975 to 1984, 1986 to 1997, and 1999 to 2009, respectively. After adjusting for several demographic characteristics, clinical factors, and inhospital complications, there were no significant differences in the odds of dying at 1-year post-discharge during the years under study. After further adjustment for hospital treatment practices, the odds of dying at 1 year post-discharge was 2.43 (95% confidence interval = 1.83 to 3.23) times higher in patients hospitalized in 1999 to 2009 than in 1975 to 1984. In conclusion, the increased use of invasive cardiac interventions and pharmacotherapies was associated with enhanced long-term survival in patients hospitalized for a first AMI.
关于首次急性心肌梗死（AMI）后出院患者长期预后趋势的基于人群的数据有限。我们的目标是描述马萨诸塞州中部所有医疗中心首次AMI后出院患者出院后死亡率的数十年趋势及其与医院管理实践的关联。1975年至2009年在马萨诸塞州中部所有医院首次AMI后出院的马萨诸塞州伍斯特市大都市区居民构成了研究人群（n = 8728）。采用多变量调整逻辑回归分析来检验住院年份与出院后1年死亡率之间的关联。该人群的平均年龄为66岁，40%为女性。与1975年至1984年出院的患者相比，1999年至2009年住院的患者年龄更大，更可能为女性，且有多种先前诊断的合并症。随着时间的推移，医院对侵入性心脏干预措施和药物的使用显著增加。1975年至1984年、1986年至1997年和1999年至2009年出院患者的未调整1年死亡率分别为12.9%、12.5%和15.8%。在对若干人口统计学特征、临床因素和住院并发症进行调整后，研究期间各年份出院后1年死亡几率无显著差异。在进一步对医院治疗实践进行调整后，1999年至2009年住院患者出院后1年死亡几率比1975年至1984年住院患者高2.43倍（95%置信区间 = 1.83至3.23）。总之，侵入性心脏干预措施和药物治疗使用的增加与首次AMI住院患者的长期生存改善相关。
