Studies of coronary heart disease (CHD) prognosis and clinical trials of secondary prevention therapies conventionally examine the first recurrent CHD event. However, quantifying the time to first event does not fully capture the patients’ need for intensive treatment and secondary prevention for CHD. In a recent retrospective cohort study, Dr. Emily B. Levitan, associate professor in the department of epidemiology at the University of Alabama at Birmingham, and colleagues examined the total burden of CHD rehospitalizations among Medicare beneficiaries following acute myocardial infarction (heart attack).
[Photo: Dr. Emily B. Levitan]
The researchers believe this study provides a perspective on the cumulative burden of disease that is complementary to more common approaches to quantify recurrent CHD. In this population of Medicare beneficiaries aged 66 years and older without prior CHD history, one in five individuals had recurrent CHD rehospitalizations in the 10 years following discharge for acute myocardial infarction, and of those, more than a third had multiple recurrent CHD rehospitalizations. These results suggest that only considering the first recurrent CHD event substantially underestimates the burden of disease among individuals with acute myocardial infarction. The associations of demographics, comorbidities, and index hospitalization characteristics with rates of first and cumulative CHD rehospitalizations were largely similar.
The team concluded that much of the burden of disease following acute myocardial infarction consists of multiple, repeated CHD rehospitalizations. Future studies should examine the extent to which risk factor modification impacts the total burden of CHD, including repeated hospitalizations.
UAB co-investigators are department colleagues Dr. Paul Muntner, professor and vice chair; Dr. Ligong Chen, statistician; and Ms. Luqin Deng, statistician; along with Dr. Meredith L. Kilgore, professor and chair, and Dr. David J. Becker, associate professor, in the department of health care organization and policy; as well as Dr. Stephen P. Glasser, professor, and Dr. Monika M. Safford, professor, in the division of preventive medicine; and Dr. George Howard, professor, in the department of biostatistics.
“Burden of Coronary Heart Disease Rehospitalizations Following Acute Myocardial Infarction in Older Adults” was published in February in the journal Cardiovascular Drugs and Therapy.
Journal article: http://link.springer.com/article/10.1007%2Fs10557-016-6653-6