Mortality and Hospitalization Rates Post-Acute MI Improve, But Not for All

Harlan M. Krumholz, MD

In the last 25 years, 10-year mortality and hospitalization rates following acute myocardial infarction (AMI) have improved – but communities such as male, Black, and dual Medicare-Medicaid-eligible patients are not seeing the same results, according to a paper published in JAMA Cardiology.

Investigators from Yale University used long-term data from Medicare beneficiaries who survived AMI in order to evaluate trends in all-cause mortality and hospitalization for recurrent AMI by demographics across a 10-year period. The study authors also looked to define the association between recurrence and mortality.

The database was chosen because most AMI occurs in those aged 65 years or older and it is the largest and most comprehensive source of long-term AMI outcome data available in the US, according to investigators.

There were 3.9 million AMI survivors included in the analysis from 1995 to 2019, with data analyzed between 2020 and 2022. The investigators noted that about half the patients were female and the mean age was 78 years. The investigators divided the 25-year study period into 5-year intervals, and found that two-thirds of the group were hospitalized from the start to 2009 and were eligible for the full 10-year follow-up.

The mean age varied from 77 years in 1995 to 78 years in 2008 and 77 years in 2019, the study authors wrote. The proportion of women also varied, from 49% to 43% across the study period. Black patients ranged from 6 to 7.2%, while patients of other races ranged from 2.5 to 7%, although that group included unreported ethnicities.

The 5 most common baseline comorbidities among the participants with AMI were atherosclerosis, hypertension, diabetes, anemia, and chronic obstructive pulmonary disease .

The study authors observed that 10-year all-cause mortality was 72.7% over the 25-year period, and it declined during each of the 5-year intervals.

“I was elated to see that on top of our progress improving short-term survival for people suffering a heart attack, that the last 2 decades has also seen remarkable improvements in long-term survival,” study author Harlan M. Krumholz, MD, SM told HCP Live®. “We have invested much effort in improving the quality of heart attack care – both at the time of hospitalization and after survival. This study shows that these efforts has improved the likely that people live a long time after a heart attack.”

Patients who were male, Black, dual Medicare-Medicaid-eligible, or living in health priority areas saw higher rates of 10-year all-cause mortality, though, the study authors found.

“I was disappointed, however, to see that repeat heart attacks, even as they are decreasing, remain too common,” Krumholz continued. “Moreover, Black Americans and people with low incomes are at higher risk, even with the improvements, and we are not making progress in health equity.”

Data show patients who were hospitalized between 1995 and 2009 had a median survival time of 1019 days to 1062 days. The risk of 10-year all-cause mortality was 13.9% lower for patients hospitalized between 2007-09 compared to those hospitalized between 1995-97, the study authors found.

Additionally, of the patients who died within the 10-year follow-up period, about a third died during the first year post-AMI. The study authors found that the 10-year recurrent AMI rate was 27.1%, but it declined over time.

“The study has reasons to celebrate and reasons to get to work,” Krumholz concluded. “We can celebrate how much progress we have made in treating heart attacks, and feel good that long-term survival continues to improve. We should get back to work because there are still people suffering from preventable events – and we are not making the needed progress in health equity. The job is not over.”

The study, "Trends in 10-Year Outcomes Among Medicare Beneficiaries Who Survived an Acute Myocardial Infarction," was published in JAMA Cardiology.