Kristi Reynolds1, Alan S Go2, Thomas K Leong3, Denise M Boudreau4, Andrea E Cassidy-Bushrow5, Stephen P Fortmann6, Robert J Goldberg7, Jerry H Gurwitz8, David J Magid9, Karen L Margolis10, Catherine J McNeal11, Katherine M Newton4, Rachel Novotny12, Charles P Quesenberry3, Wayne D Rosamond13, David H Smith6, Jeffrey J VanWormer14, Suma Vupputuri15, Stephen C Waring16, Marc S Williams17, Stephen Sidney3. 1. Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, Calif. Electronic address: Kristi.Reynolds@kp.org. 2. Division of Research, Kaiser Permanente Northern California, Oakland, Calif; Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, Calif; Department of Health Research and Policy, Stanford University School of Medicine, Calif. 3. Division of Research, Kaiser Permanente Northern California, Oakland, Calif. 4. Group Health Research Institute, Seattle, Wash. 5. Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich. 6. Kaiser Permanente Center for Health Research, Portland, Ore. 7. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Pa. 8. Meyers Primary Care Institute, A Joint Endeavor of Fallon Health, Reliant Medical Group, and University of Massachusetts Medical School, Worcester, Pa. 9. Colorado Permanente Medical Group, Denver; Colorado School of Public Health, University of Colorado Denver, Aurora; Colorado Cardiovascular Outcomes Research Consortium, Denver. 10. HealthPartners Institute for Education and Research, Minneapolis, Minn. 11. Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Health, Temple, Tex. 12. Human Nutrition, Food and Animal Science Department, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu. 13. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. 14. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Wis. 15. Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Md. 16. Division of Research, Essentia Institute of Rural Health, Duluth, Minn. 17. Genomic Medicine Institute, Geisinger Health System, Danville, Pa.
Abstract
BACKGROUND: Monitoring trends in cardiovascular events can provide key insights into the effectiveness of prevention efforts. Leveraging data from electronic health records provides a unique opportunity to examine contemporary, community-based trends in acute myocardial infarction hospitalizations. METHODS: We examined trends in hospitalized acute myocardial infarction incidence among adults aged ≥25 years in 13 US health plans in the Cardiovascular Research Network. The first hospitalization per member for acute myocardial infarction overall and for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction was identified by International Classification of Diseases, Ninth Revision, Clinical Modification primary discharge codes in each calendar year from 2000 through 2008. Age- and sex-adjusted incidence was calculated per 100,000 person-years using direct adjustment with 2000 US census data. RESULTS: Between 2000 and 2008, we identified 125,435 acute myocardial infarction hospitalizations. Age- and sex-adjusted incidence rates (per 100,000 person-years) of acute myocardial infarction decreased an average 3.8%/y from 230.5 in 2000 to 168.6 in 2008. Incidence of ST-segment elevation myocardial infarction decreased 8.7%/y from 104.3 in 2000 to 51.7 in 2008, whereas incidence of non-ST-segment elevation myocardial infarction increased from 126.1 to 129.4 between 2000 and 2004 and then decreased thereafter to 116.8 in 2008. Age- and sex-specific incidence rates generally reflected similar patterns, with relatively larger decreases in ST-segment elevation myocardial infarction rates in women compared with men. As compared with 2000, the age-adjusted incidence of ST-segment elevation myocardial infarction in 2008 was 48% lower among men and 61% lower among women. CONCLUSIONS AND RELEVANCE: Among a large, diverse, multicenter community-based insured population, there were significant decreases in incidence of hospitalized acute myocardial infarction and the more serious ST-segment elevation myocardial infarctions between 2000 and 2008. Decreases in ST-segment elevation myocardial infarctions were most pronounced among women. While ecologic in nature, these secular decreases likely reflect, at least in part, results of improvement in primary prevention efforts.
BACKGROUND: Monitoring trends in cardiovascular events can provide key insights into the effectiveness of prevention efforts. Leveraging data from electronic health records provides a unique opportunity to examine contemporary, community-based trends in acute myocardial infarction hospitalizations. METHODS: We examined trends in hospitalized acute myocardial infarction incidence among adults aged ≥25 years in 13 US health plans in the Cardiovascular Research Network. The first hospitalization per member for acute myocardial infarction overall and for ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction was identified by International Classification of Diseases, Ninth Revision, Clinical Modification primary discharge codes in each calendar year from 2000 through 2008. Age- and sex-adjusted incidence was calculated per 100,000 person-years using direct adjustment with 2000 US census data. RESULTS: Between 2000 and 2008, we identified 125,435 acute myocardial infarction hospitalizations. Age- and sex-adjusted incidence rates (per 100,000 person-years) of acute myocardial infarction decreased an average 3.8%/y from 230.5 in 2000 to 168.6 in 2008. Incidence of ST-segment elevation myocardial infarction decreased 8.7%/y from 104.3 in 2000 to 51.7 in 2008, whereas incidence of non-ST-segment elevation myocardial infarction increased from 126.1 to 129.4 between 2000 and 2004 and then decreased thereafter to 116.8 in 2008. Age- and sex-specific incidence rates generally reflected similar patterns, with relatively larger decreases in ST-segment elevation myocardial infarction rates in women compared with men. As compared with 2000, the age-adjusted incidence of ST-segment elevation myocardial infarction in 2008 was 48% lower among men and 61% lower among women. CONCLUSIONS AND RELEVANCE: Among a large, diverse, multicenter community-based insured population, there were significant decreases in incidence of hospitalized acute myocardial infarction and the more serious ST-segment elevation myocardial infarctions between 2000 and 2008. Decreases in ST-segment elevation myocardial infarctions were most pronounced among women. While ecologic in nature, these secular decreases likely reflect, at least in part, results of improvement in primary prevention efforts.
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