Mortalidad a largo plazo y reingreso hospitalario tras infarto agudo de miocardio: un estudio de seguimiento de ocho años / Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study

Introducción y objetivos. El infarto agudo de miocardio es en los países desarrollados la causa más importante de mortalidad, así como de un gran número de ingresos hospitalarios. Concretamente, en España cada año se producen alrededor de 140.000 muertes y 5 millones de hospitalizaciones a causa de infarto agudo de miocardio, lo cual corresponde a unos costes de asistencia sanitaria que suponen un 15% de los gastos totales. En este artículo se presenta, pues, un análisis exhaustivo del infarto agudo de miocardio y el pronóstico que comporta en cuanto a recurrencia y mortalidad. Métodos. Este estudio observacional se llevó a cabo en España. Los datos se obtuvieron de la Base de Datos Administrativa de Altas Hospitalarias para el periodo comprendido entre 2000 y 2007, ambos inclusive. Concretamente, se registraron 12.096 casos de infarto agudo de miocardio (8.606 mujeres y 3.490 varones) durante ese periodo, con un total de 2.395 reingresos por ese diagnóstico. Se analizó la frecuencia y la duración de los reingresos mediante regresión logística y con el modelo de supervivencia de Wang. La mortalidad se analizó mediante una regresión logística. Resultados. Las tasas de reingreso fueron del 50% en los pacientes de menos de 45 años y del 38% en los de más de 75 años (p<0,001). Los varones reingresaron con mayor frecuencia que las mujeres durante todo el periodo de seguimiento. Las variables relacionadas con la mortalidad hospitalaria por infarto agudo de miocardio fueron diabetes mellitus, antecedentes de cardiopatía isquémica y enfermedad cerebrovascular. Conclusiones. Los reingresos hospitalarios a medio plazo son muy frecuentes en los pacientes que sobreviven a un infarto agudo de miocardio. El sexo masculino, los antecedentes de enfermedad coronaria y el número de factores de riesgo cardiovascular clásicos son factores predictivos importantes del riesgo de reingreso. Nuestros resultados resaltan la necesidad de una mejora de la asistencia médica durante el ingreso por infarto agudo de miocardio, de manera integrada en los programas de prevención secundaria (AU)

Introduction and objectives. Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140 000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. Methods. This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12 096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. Results. Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. Conclusions. Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs (AU)

Psychiatric morbidity as a risk factor for hospital readmission for acute myocardial infarction: an 8-year follow-up study in Spain.

BACKGROUND AND OBJECTIVE: Most previous studies assess the effect of depression and other psychiatric variables as risk factors for acute myocardial infarction; however, studies that assess the effect of psychiatric disorders as a whole are scarce, compared with other non-psychiatric factors. The aim of this study is to assess the importance of psychiatric morbidity, compared with other risk factors, in hospital readmission for acute myocardial infarction. METHODS: This is a 8-year follow-up study in which the Hospital Discharge Administrative Database was used. RESULTS: From the total sample (11,062 patients), 590 patients (4.88%) were diagnosed with some mental disorder. Psychiatric disorders were more common in women than in men with myocardial infarction (4.76 % and 6.20%, respectively, p-value = 0.002). For those who have had recurrence of stroke, mental disease influences in the consecutive readmission for AMI with the same severity as did tobacco, diabetes, or obesity. CONCLUSIONS: The main finding of this study is the enormous impact of psychiatric disorders on readmissions for AMI, comparable to diabetes, obesity, cerebral vascular disease, and hypertension. Interestingly, the efforts made to treat and prevent psychiatric disorders in AMI patients are clearly lower than those health authorities make with respect to classic risk factors.

Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study.

INTRODUCTION AND OBJECTIVES: Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140,000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality. METHODS: This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12,096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression. RESULTS: Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease. CONCLUSIONS: Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs.

Factores de riesgo cardiovascular y estilo de vida asociados a la aparición prematura de infarto agudo de miocardio / Cardiovascular risk factors and lifestyle associated with premature myocardial infarction diagnosis

Los pacientes jóvenes diagnosticados de infarto agudo de miocardio tienen diferente perfil de riesgo cardiovascular, presentación clínica, hallazgos angiográficos y pronóstico que los demás pacientes. En este estudio se analizan las características y la evolución de los pacientes diagnosticados de infarto agudo de miocardio con edad < 46 años (AU)

Young and old patients with acute myocardial infarction have different risk factor profiles, clinical presentation, angiographic findings and prognosis. In the present study we investigated the clinical profile of patients aged <46 years with acute myocardial infarction (AU)

[Cardiovascular risk factors and lifestyle associated with premature myocardial infarction diagnosis]. / Factores de riesgo cardiovascular y estilo de vida asociados a la aparición prematura de infarto agudo de miocardio.

Young and old patients with acute myocardial infarction have different risk factor profiles, clinical presentation, angiographic findings and prognosis. In the present study we investigated the clinical profile of patients aged <46 years with acute myocardial infarction.

Hospitalizations for ambulatory care sensitive conditions and quality of primary care: their relation with socioeconomic and health care variables in the Madrid regional health service (Spain).

BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSH) have been proposed as an indirect indicator of the effectiveness and quality of care provided by primary health care. OBJECTIVE: To investigate the association of ACSH rates with population socioeconomic factors and with characteristics of primary health care. RESEARCH DESIGN: Cross-sectional, ecologic study. Using hospital discharge data, ACSH were selected from the list of conditions validated for Spain. SETTING: All 34 health districts in the Region of Madrid, Spain. SUBJECTS: Individuals aged 65 years or older residing in the region of Madrid between 2001 and 2003, inclusive. MEASURES: Age- and gender-adjusted ACSH rates in each health district. RESULTS: The adjusted ACSH rate per 1000 population was 35.37 in men and 20.45 in women. In the Poisson regression analysis, an inverse relation was seen between ACSH rates and the socioeconomic variables. Physician workload was the only health care variable with a statistically significant relation (rate ratio of 1.066 [95% CI; 1.041-1.091]). These results were similar in the analyses disaggregated by gender. In the multivariate analyses that included health care variables, none of the health care variables were statistically significant. CONCLUSIONS: ACSH may be more closely related with socioeconomic variables than with characteristics of primary care activity. Therefore, other factors outside the health system must be considered to improve health outcomes in the population.

Geographic variations in avoidable hospitalizations in the elderly, in a health system with universal coverage.

BACKGROUND: The study of Hospitalizations for ambulatory care sensitive conditions (ACSH) has been proposed as an indirect measure of access to and receipt of care by older persons at the entryway to the Spanish public health system. The aim of this work is to identify the rates of ACSH in persons 65 years or older living in different small-areas of the Community of Madrid (CM) and to detect possible differences in ACSH. METHODS: Cross-sectional, ecologic study, which covered all 34 health districts of the CM. The study population consisted of all individuals aged 65 years or older residing in the CM between 2001 and 2003, inclusive. Using hospital discharge data, avoidable ACSH were selected from the list of conditions validated for Spain. Age- and sex-adjusted ACSH rates were calculated for the population of each health district and the statistics describing the data variability. Point graphs and maps were designed to represent the ACSH rates in the different health districts. RESULTS: Of all the hospitalizations, 16.5% (64,409) were ACSH. Globally, the rate was higher among men: 33.15 per 1,000 populations vs. 22.10 in women and these differences were statistically significant (p < 0.05) in each district. For men the range was 70.82 and the coefficient of variation (CV) was 0.47, while for women the range was 43.69 and the CV was 0.48. In 93.1% of cases, the ACSH were caused by hypertensive cardiovascular disease, heart failure or pneumonia. A centripetal pattern can be observed, with lower rates in the districts in the center of the CM. This geographic distribution is maintained after grouping by sex. CONCLUSION: A significant variation is demonstrated in "preventable" hospitalizations between the different districts. In all the districts the men present rates significantly higher than women. Important variations in the access are observed the Primary Attention in spite of existing a universal sanitary cover.