Care and outcomes of first-time myocardial infarction among vulnerable populations in Denmark, 2003–22: a nationwide registry-based cohort study

Fig. 1. Flowchart of the study population∗∗. Flowchart with inclusion and exclusion criteria. Patients were excluded if they had emigrated prior to their first-time MI and if there were missing data regarding their patient characteristics. For prior diagnosis of MI and MACE, including HF, stroke, and TIA, both primary and secondary diagnosis for inpatients and outpatients were used. ∗ICD-codes: Myocardial infarction ICD-10: I21, I22; ICD-8: 410. MACE, major adverse cardiac events, ICD-10: I110, I130, I132, I42, I50, I60, I61, I63, I64, J819, G45; ICD-8: 425, 428, 4270, 4271, 430, 431, 432, 433, 434, 435, 436. ∗∗Patients may appear in more than one potentially vulnerable subgroup. Patients in the ‘Counterpart’-group does not possess the patient characteristic that defines the respective potentially vulnerable subgroup. Abbreviations: MI: Myocardial infarction, MACE: Major Adverse Cardiovascular Events, HF: Heart Failure, TIA: Transient Ischemic Attack, ICD: International Classification of Disease.

Fig. 2. Percent patients receiving statin, DAPT and cardiovascular procedure in 2003–2007 and 2018–2022. Bar plots showcasing for each of the subpopulations, the proportion of patients receiving statins and DAPT from 180 days before to 90 days after diagnosis, and having undergone a new cardiovascular procedure within the first 90 days after diagnosis. The left column depicts treatment in 2003–2007, and the right column depicts treatment in 2018–2022. In each of the plots, the bars for the potentially vulnerable populations are depicted with a solid colour, whereas the bars for their counterparts are outlined with the same colour. Abbreviations: DAPT: Dual Anti-Platelet Therapy.

Fig. 3. First-time myocardial infarction and the probability of receiving therapy for potentially vulnerable subgroups in 2018–2022 compared to 2003–2007. Forest plot showcasing for the entire population and for each of the subpopulations, the adjusted ORs with corresponding CIs for redeeming statins and DAPT from 180 days before to 90 days after diagnosis, and for undergoing a new cardiovascular procedure within the first 90 days after diagnosis, comparing the year group 2003–2007 with 2018–2022. Abbreviations: OR: Odds ratio, CI: Confidence Interval, DAPT: Dual Anti-Platelet Therapy.

Fig. 4. First-time myocardial infarction and the absolute and adjusted mortality risks for potentially vulnerable subgroups, in 2018–2022 compared to 2003–2008. Forest plot showcasing for the entire population and for each of the subpopulations, the number of patients and AR for 5-year all-cause mortality for the year group 2003–2007 and 2018–2022. Furthermore, the adjusted HRs for 5-year all-cause mortality with corresponding CIs are showcased, as well as the interaction p-value for the temporal trend. HRs were adjusted for each of the 8 patient characteristics defining the potentially vulnerable subgroups: Age ≥ 80, female sex, frail, living alone, living in rural area, non-Western immigrant, history of mental illness, and low income. Abbreviations: AR: Absolute Risk, HR: Hazard ratio, CI: Confidence interval.

Fig. 5. Cumulative incidence of 5-year all-cause mortality in 2003–2007 and 2018–2022, comparing the potentially vulnerable subgroups with their counterparts.∗ Cumulative incidence of 5-year all-cause mortality for all potentially vulnerable groups and their respective counterparts, for the first and last calendar periods, 2003–2007 and 2018–2022. ∗Patients in the ‘Counterpart’-group does not possess the patient characteristic that defines the respective potentially vulnerable subgroup.