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Increased Cardiovascular and Mortality Risk in Older MI Survivors
According to a study published online, older myocardial infarction (MI) survivors have long-term elevated risks of mortality and cardiovascular events (Cardiovascular Theraputics. doi: 10.1111/1755-5922.12222).
Research associate Erru Yang (Evidera, Lexington, MA) and colleagues examined long-term outcomes and health-care costs among elderly MI survivors in a retrospective analysis of 2002-2009 Medicare health care claims. Patients were 65 years old or older and survived one year or more without recurrent MI after hospitalization for MI. Data were included for 16,244 ST-segment elevation myocardial infarction (STEMI) patients, 34,576 non-STEMI (NSTEMI) patients, and 3,109 patients with unspecified MI.
The researchers found that the prevalence of comorbidities, except for hypertension and dyslipidemia, was significantly higher for NSTEMI and unspecified MI patients than for STEMI patients. Over the follow-up, MI incidence declined 36% (3.82 to 2.45/100 person-years).
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There were decreases in mortality, stroke, and bleeding until the third year of follow-up; increases were seen thereafter. Throughout follow-up, the incidence of death, MI, the composite, and bleeding was significantly higher for NSTEMI and unspecified MI patients than STEMI patients. For STEMI and NSTEMI during follow-up, all-cause inpatient costs were 2.6- and 1.9-fold higher, respectively, than baseline during follow-up; cardiovascular-related inpatient costs were 3.5- and 2.2-fold higher, respectively.
Authors concluded that risks of mortality and cardiovascular events remain high in a Medicare population surviving > 1 year after a MI. Continuing health-care costs are doubled over pre-MI levels up to five years after an MI. Secondary prevention measures beyond the acute post-MI period may be indicated to reduce risk and cost in this chronic disease phase. —Amanda Del Signore
