Weekly journal scan: excess incidence of unexpected health outcomes following myocardial infarction—broader paths for secondary prevention

Key Points• Health outcomes after myocardial infarction (MI) were explored in a nationwide cohort study of ∼34 million people, older than 18 years, admitted to one of the 229 National Health Service (NHS) Trusts in England, between 2008 and 2017.Hospital Episode Statistics (HES) data were extracted and linked to data derived from the Office of National Statistics.• All-cause mortality and 11 non-fatal outcomes were measured, including those typically described in secondary prevention guidelines, such as recurrent MI and heart failure (HF), and those sharing common risk factors with MI, such as peripheral arterial disease (PAD), cerebrovascular disease, and chronic renal failure.Other recorded life-threatening outcomes included severe bleeding, diabetes, atrial fibrillation (AF), and different forms of cancer; finally, the incidence of health outcomes with a potential impact on length and quality of life, such as depression and dementia, was also explored.Patients' characteristics and health outcomes of post-MI patients were compared with those of people entering any of the NHS trusts with diseases different from MI and with an age-, sex-, and year-matched population hospitalized in England.• Among the 33 885 223 hospitalized patients with good data quality, after the exclusion of patients admitted with any of the outcomes of the study before the MI and a pre-matched entry date, the MI analytical cohort included 433 361 patients, the non-MI cohort was made of 33 429 669 patients, and a cohort of 2 001 310 patients was used as a matched control.In the MI cohort, 65.5% were males and mean age was 67.4 ± 14.4 years.As compared with the matched control group, MI patient cohort showed higher prevalence of hypertension (48.8% vs. 36.9%),dyslipidaemia (29.5% vs. 11.9%),obesity (5.9% vs. 3.7%), and tobacco smoking (28.8% vs. 11.4%).Alcohol abuse was lower in MI than in the control cohort (3.9% vs. 4.6%).• The adjusted cumulative incidence at 9 years post-MI was highest for all-cause mortality [37.8%; 95% confidence interval (CI), 37.6-37.9]followed by HF (29.6%; 95% CI, 29.4-29.7),renal failure (27.2%; 95% CI, 27.0-27.4),AF (22.3%; 95% CI, 22.2-22.5),severe bleeding (19.0%; 95% CI, 18.8-19.1),diabetes mellitus (17.0%; 95% CI, 16.9-17.1),cancer (13.5%; 95% CI, 13.3-13.6),cerebrovascular disease (12.5%; 95% CI, 12.4-12.7),depression (8.9%; 95% CI, 8.7-9.0),dementia (7.8%; 95% CI, 7.7-7.9),subsequent MI (7.1%; 95% CI, 7.0-7.2),and PAD (6.5%; 95% CI, 6.3-6.5).• Excess rates of outcomes, calculated as the hazard ratio (HR), for each outcome compared with matched controls, were as follows: HF, 4.93 (4.89-4.97),P < .001;AF, 1.98 (1.97-2.00),P < .001;cerebrovascular disease, 1.25 (1.23-1.26),P < .001;PAD, 1.86 (1.83-1.89),P < .001;severe bleeding, 1.22 (1.20-1.23),P < .001;renal failure, 1.77 (1.75-1.78),P < .001;dementia, 1.01 (0.99-1.02),P < .001;depression, 1.06 (1.04-1.07),P < .001;and all cancers, 0.56 (0.56, 0.57), P < .001.• Age-, gender-, and socioeconomic deprivation-specific risk charts were produced for all-cause mortality and non-fatal health outcomes following MI.Socioeconomic deprivation refers to a lack of sufficient social and/or economic resources.This analysis highlighted that inequalities related to age, sex, and socioeconomic deprivation were associated with earlier MI and an increased burden of post-MI health outcomes.It also showed that post-MI depression risk was highest among younger women belonging to the high deprivation score classes.