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. 2012 Jan 25:344:e356.
doi: 10.1136/bmj.e356.

25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study

Morten Schmidt  1 , Jacob Bonde Jacobsen, Timothy L Lash, Hans Erik Bøtker, Henrik Toft Sørensen
Affiliations

25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study

Morten Schmidt et al. BMJ. .

Abstract

Objectives: To examine 25 year trends in first time hospitalisation for acute myocardial infarction in Denmark, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity.

Design: Nationwide population based cohort study using medical registries.

Setting: All hospitals in Denmark.

Subjects: 234,331 patients with a first time hospitalisation for myocardial infarction from 1984 through 2008.

Main outcome measures: Standardised incidence rate of myocardial infarction and 30 day and 31-365 day mortality by sex. Comorbidity categories were defined as normal, moderate, severe, and very severe according to the Charlson comorbidity index, and were compared by means of mortality rate ratios based on Cox regression.

Results: The standardised incidence rate per 100,000 people decreased in the 25 year period by 37% for women (from 209 to 131) and by 48% for men (from 410 to 213). The 30 day, 31-365 day, and one year mortality declined from 31.4%, 15.6%, and 42.1% in 1984-8 to 14.8%, 11.1%, and 24.2% in 2004-8, respectively. After adjustment for age at time of myocardial infarction, men and women had the same one year risk of dying. The mortality reduction was independent of comorbidity category. Comparing patients with very severe versus normal comorbidity during 2004-8, the mortality rate ratio, adjusted for age and sex, was 1.96 (95% CI 1.83 to 2.11) within 30 days and 3.89 (3.58 to 4.24) within 31-365 days.

Conclusions: The rate of first time hospitalisation for myocardial infarction and subsequent short term mortality both declined by nearly half between 1984 and 2008. The reduction in mortality occurred for all patients, independent of sex and comorbidity. However, comorbidity burden was a strong prognostic factor for short and long term mortality, while sex was not.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) no authors have support from any company for the submitted work. Department of Clinical Epidemiology is, however, involved in studies with funding from various companies as research grants to (and administered by) Aarhus University. None of these studies have relation to the present study; (2) no authors have relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) no authors have non-financial interests that may be relevant to the submitted work.

Figures

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Fig 1 Standardised incidence rates for first time hospitalisation for myocardial infarction in Denmark between 1984 and 2008 among men and women
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Fig 2 Standardised incidence rates for first time hospitalisation for myocardial infarction between 1984 and 2008, for men and women within age groups
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Fig 3 Standardised 30 day and 31–365 day mortality after first time hospitalisation for myocardial infarction among men and women between 1984 and 2008.
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Fig 4 30 day and 31–365 day mortality after first time hospitalisation for myocardial infarction between 1984 and 2008, according to comorbidity category.
See this image and copyright information in PMC

Comment in

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