Key result
Recurrent myocardial infarction in older US adults was associated with a significantly higher risk of death (HR 2.04) and impoverishment (HR 1.32) compared to experiencing an initial MI only.
Why the study?
It was unknown whether recurrent myocardial infarction is associated with increased risk of mortality, long-term nursing home placement, and impoverishment.
Does recurrent myocardial infarction increase the risk of mortality, long-term nursing home placement, and impoverishment in older US adults compared to those with only an initial MI?
Cohort (n=1,144,130)
Does recurrent myocardial infarction increase the risk of mortality, long-term nursing home placement, and impoverishment in older US adults compared to those with only an initial MI?
Recurrent myocardial infarction in older adults is associated with a doubled risk of mortality and a 32% increased risk of impoverishment compared to those with only an initial MI.
Answers are grounded in this paper and cite their sources.
Supports intensified secondary prevention after initial MI in older adults; extends observational data to include impoverishment risk.
Study objective: To determine whether recurrent myocardial infarction (MI) is associated with increased risk of mortality, long-term nursing home placement, and impoverishment. Design: Retrospective cohort study. Setting: United States Medicare program. Participants: = 915,304). Main outcome measures: Death, nursing home placement, and impoverishment (Medicaid enrollment or subsidies for low-income and -resource individuals) through December 31, 2017. Results: In the recurrent MI and control cohorts, 47% and 41% of individuals were age > 80 years, respectively, and 56% of both cohorts were women. After 1 year, 48% of the recurrent MI cohort and 16% of the control cohort died, 9% and 7% experienced nursing home placement, and 4% and 2% experienced impoverishment. Multivariable-adjusted hazard ratios (95% confidence intervals) comparing the recurrent MI and control cohorts were 2.04 (2.03-2.06) for death, 0.89 (0.88-0.91) for nursing home placement, and 1.32 (1.28-1.36) for impoverishment. Conclusions: Older US adults with recurrent MI had higher risk of death and impoverishment than controls who had experienced an initial MI. Unadjusted, recurrent MI was associated with higher risk of nursing home placement; however, after adjusting for sociodemographic characteristics and comorbidities, individuals with recurrent MI had slightly lower risk of nursing home placement. Preventing recurrent MI may also reduce the risk of death and impoverishment among older US adults.
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Levitan et al. (2021) conducted a cohort in Recurrent myocardial infarction (n=1,144,130). Recurrent myocardial infarction vs. Initial myocardial infarction without recurrence was evaluated on Death (HR 2.04, 95% CI 2.03-2.06). Recurrent myocardial infarction in older US adults was associated with a significantly higher risk of death (HR 2.04) and impoverishment (HR 1.32) compared to experiencing an initial MI only.
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