Trends in Short-, Intermediate-, and Long-Term Mortality Following Hospitalization for Myocardial Infarction Among Medicare Beneficiaries, 2008 to 2018

Abstract

BACKGROUND: Advances in technology and care quality have transformed the care of acute myocardial infarction (AMI), but little is known about trends in mortality rates across separate time periods after hospitalization. METHODS AND RESULTS: We identified all Medicare fee-for-service beneficiaries hospitalized with incident AMI from 2008 to 2018. We calculated unadjusted mortality rates by dividing the number of all-cause deaths by the number of patients with incident AMI for the following time periods: acute (in hospital), post acute (0–30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1–2 years after discharge), and long term (2–3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Using logistic regression to account for differences in patient characteristics, we calculated annual risk standardized mortality ratios defined as observed over expected mortality based on 2008 rates. Among 768 084 patients with incident AMI (mean age 81 years, 48% male, 87% White), declines in observed-to-expected mortality ratios were observed for each time period: acute (0.68 [95% CI, 0.66–0.71]), postacute (0.72 [95% CI, 0.71–0.75]), short term (0.77 [95% CI, 0.75–0.78]), intermediate term (0.79 [95% CI, 0.77–0.81]), and long term (0.77 [95% CI, 0.75–0.79]). Declines were observed both for patients with and without ST-segment–elevation AMI. CONCLUSIONS: For patients with incident AMI, there have been improvements in mortality rates across periods spanning the hospital stay through 3 years after discharge, reflecting advances in AMI care from hospitalization through long-term outpa-tient follow-up.