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Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland.

ABSTRACT: To assess temporal trends of in-hospital mortality in patients with acute myocardial infarction (AMI) enrolled in the Swiss nationwide registry (AMIS Plus) over the last 20 years with regard to gender, age and in-hospital treatment.All patients with AMI from 1997 to 2016 were stratified according to ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI), and gender using logistic regression analyses.Among 51?725 patients, 30?398 (59%) had STEMI and 21?327 (41%) had NSTEMI; 73% were men (63.9±12.8 years) and 27% were women (71.7±12.5 years). Over 20 years, crude in-hospital STEMI mortality decreased from 9.8% to 5.5% in men and from 18.3% to 6.9% in women. In patients with NSTEMI, it decreased from 7.1% to 2.1% in men and from 11.0% to 3.6% in women. After adjustment for age, mortality decreased per additional admission year by 3% in men with STEMI (OR 0.97, 95%?CI 0.96 to 0.98, P<0.001), by 5% in women with STEMI (OR 0.95, 95%?CI 0.93 to 0.96, P<0.001), by 6% in men with NSTEMI (OR 0.94, 95%?CI 0.93 to 0.96, P<0.001) and by 5% in women with NSTEMI (OR 0.95, 95%?CI 0.93 to 0.97, P<0.001). In patients <60 years, a decrease in mortality was seen in women with STEMI (OR 0.94, 95%?CI 0.90 to 0.99, P=0.025) and NSTEMI (OR 0.87, 95%?CI 0.80 to 0.94, P<0.001) but not in men with STEMI (OR 1.01, 95%?CI 0.98 to 1.04, P=0.46) and NSTEMI (OR 0.98, 95%?CI 0.94 to 1.03, P=0.41). The mortality decrease in patients with AMI was closely associated with the increase in reperfusion therapy.From 1997 to 2016, in-hospital mortality of patients with AMI in Switzerland has halved and was more pronounced in women, particularly in the age category <60 years.NCT01305785; Results.

SUBMITTER: Radovanovic D

PROVIDER: S-EPMC5687526 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland.

Radovanovic Dragana D Seifert Burkhardt B Roffi Marco M Urban Philip P Rickli Hans H Pedrazzini Giovanni G Erne Paul P

Open heart 20171114 2

<h4>Objective</h4>To assess temporal trends of in-hospital mortality in patients with acute myocardial infarction (AMI) enrolled in the Swiss nationwide registry (AMIS Plus) over the last 20 years with regard to gender, age and in-hospital treatment.<h4>Methods</h4>All patients with AMI from 1997 to 2016 were stratified according to ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI), and gender using logistic regression analyses.<h4>Results</h4>Among 51 725 patients, 30 398 ...[more]

PMID: 29177059

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Project description:BackgroundPublicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes.ObjectiveTo examine the relationship between hospital 30-day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI.DesignRetrospective cohort study.Setting986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines.ParticipantsAdults hospitalized for AMI from 1 October 2010 to 30 September 2014.MeasurementsHospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure.Results267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4%, 3.0%, and 6.2% for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92).LimitationMinority of U.S. hospitals.ConclusionHospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the presence and effect of age-related quality differences.Primary funding sourceAmerican College of Cardiology.

Project description:BackgroundFemale sex was reported to be associated with an unfavorable outcome in acute myocardial infarction (AMI). In this nationwide analysis we assessed sex differences in acute outcomes of AMI and recent trends in patient healthcare.MethodsWe analyzed 875 735 German cases hospitalized with a main diagnosis of ST- (STEMI) and non ST-elevation myocardial infarction (NSTEMI) between January 01 2014 and December 31 2017 regarding morbidity, in-hospital mortality and treatments. A multivariable logistic regression model was designed to evaluate the use of interventions and their impact on in-hospital mortality.ResultsSTEMI cases decreased from 72 894 in 2014 to 68 213 in 2017, with 70% assignable to men. Female sex was associated with older age (74 vs. 62 years), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (19.2% vs. 12.5%), hypertension (69.0% vs. 65.0%) and left ventricular heart failure (36.0% vs. 32.1%). In NSTEMI, female sex was also associated with older age (78 vs. 71 years), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (29.7% vs. 23.9%), hypertension (77.4% vs. 74.5%) and left ventricular heart failure (40.5% vs. 36.4%). Overall, 74.3% of female and 81.3% of male STEMI cases received percutaneous coronary intervention (PCI, p < 0.001). In NSTEMI, PCI was performed in 40.8% of female and 52.0% of male cases (p < 0.001). In-hospital mortality was notably increased in female patients with STEMI (15.0% vs. 9.6%; p < 0.001; OR 1.07; 95% CI 1.03-1.10) and NSTEMI (8.3% vs. 6.3%; p < 0.001; OR 0.91; 95% CI 0.89-0.93) compared to males.ConclusionsOur nationwide real-world data document that in-patient STEMI cases continue to decrease in women and men. The observed higher in-hospital mortality in women was largely attributed to a more unfavorable risk and age distribution rather than to female-intrinsic factors. Women with AMI continue to be less likely to receive revascularization therapies.

Dataset Information

Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland.

Publications

Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland.

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