A 35-Year Perspective (1975 to 2009). into the Long-Term Prognosis and Hospital Management of Patients Discharged from the Hospital After a First Acute Myocardial Infarction
A 35-Year Perspective (1975 to 2009). into the Long-Term Prognosis and Hospital Management of Patients Discharged from the Hospital After a First Acute Myocardial Infarction
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DOI：
10.1016/j.amjcard.2015.03.035
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发表时间：
2015-07-01
影响因子：
2.8
通讯作者：
Goldberg, Robert J.
中科院分区：
文献类型：
--
作者：
Chen, Han-Yang;Gore, Joel M.;Goldberg, Robert J.
有有限的基于人群的数据来描述初次急性心肌梗死（AMI）后出院患者的长期预后趋势。我们的目的是描述马萨诸塞州中部所有医疗中心首次急性心肌梗死后出院患者出院后死亡率的几十年趋势及其与医院管理实践的关系。1975年至2009年首次急性心肌梗塞后从马萨诸塞州伍斯特市大都会区出院的居民构成了研究人群（n = 8,728）。采用多变量调整logistic回归分析检验住院时间与出院后1年死亡率之间的关系。这些人的平均年龄为66岁，其中40%是女性。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，更有可能是女性，并且有多种先前诊断的合并症。随着时间的推移，医院使用有创心脏介入治疗和药物治疗显著增加。1975年至1984年、1986年至1997年和1999年至2009年出院的患者未经调整的1年死亡率分别为12.9%、12.5%和15.8%。在调整了几个人口特征之后；临床因素和院内并发症，在研究期间，出院后1年死亡的几率没有显著差异。在进一步调整医院治疗实践后，1999 - 2009年住院患者出院后1年死亡的几率是1975 - 1984年住院患者的2.43倍（95%可信区间= 1.83 ~ 3.23）。总之，有创心脏介入治疗和药物治疗的增加与首次急性心肌梗死住院患者的长期生存率提高有关。(C) 2015爱思唯尔公司版权所有。
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. (C) 2015 Elsevier Inc. All rights reserved.