Impacto de las comorbilidades en la mortalidad hospitalaria por infarto agudo de miocardio durante el periodo 2003-2009

Abstract

Despite the fact that the mean age and number of comorbidities in acute myocardial infarction patients has increased year over year, acute myocardial infarction mortality has decreased, probably because of more frequent reperfusion and revascularization therapy and better medical treatment.

Magnitude and Impact of Multimorbidity on Clinical Outcomes in Older Adults with Cardiovascular Disease

“…Five studies included patients with acute myocardial infarction, and 10 included patients with heart failure as the cardiovascular condition of interest. Six of the included studies were retrospective cohort studies, 3,9,10,12,14 four were cross-sectional, 5,15,16,17 three were prospective cohort studies, 18,19,20 and two were randomized controlled trials. 21,22 Seven were US-based studies; 3,5,9,10,14,16,20 non-US-based studies (n= 8) were performed in Canada 13,22 and several European countries , including Italy, 17 Spain, 15 Portugal, 12 Denmark, 21 France, 18 and the Netherlands.…”

“…Six of the included studies were retrospective cohort studies, 3,9,10,12,14 four were cross-sectional, 5,15,16,17 three were prospective cohort studies, 18,19,20 and two were randomized controlled trials. 21,22 Seven were US-based studies; 3,5,9,10,14,16,20 non-US-based studies (n= 8) were performed in Canada 13,22 and several European countries , including Italy, 17 Spain, 15 Portugal, 12 Denmark, 21 France, 18 and the Netherlands. 19 Eleven studies utilized medical records for data collection, 3,5,9,10,12,13,15,18,19,20,21 three employed claims-based data, 14,16,17 and one group of authors analyzed data on multimorbidity collected in the context enrolling subjects in a large randomized controlled trial (SOLVD).…”

“…The number of chronic conditions was assessed by simple counts of chronic conditions 3,5,9,10,12,14,16,18,20,21,22 (n=11), by combination of the Elixhauser and Charlson indices 15 (n=1), and by the Charlson index alone 13, 17, 19 (n=3) (Table 2). The prevalence of chronic conditions ranged from at least one additional morbidity in 10% 5 to 77% 9 of persons; the frequency of four or more additional chronic conditions ranged from 5% 9 to 60%.…”

“…19 Three studies found a significant association between number of morbidities and the hospital case fatality rate (CFR), 5,10,12 and one study reported a significant association between a higher Charlson score and hospital CFR. 15 As an example, of the positive association between number of morbidities and long term-mortality, one study found that in a cohort of 9,500 patients hospitalized due to an acute myocardial infarction, one-year mortality odds ratio (ORs) ranged from 1.16 (1.01; 1.34) to 2.31 (1.92; 2.78) for those presenting with one or four or more chronic conditions, respectively, as compared to those without any chronic conditions. 9 Another study found that patients with heart failure and hypertension had a hazard ratio (HR) for death of 1.32 (1.12;1.54) and those presenting with heart failure and diabetes had a HR of 1.55 (1.28;1.88), as compared to those without these chronic conditions.…”

“…10 As an example of studies that examined the impact of specific chronic conditions on mortality, in a cohort of 5,275 patients that had experienced a previous hospitalization for an acute myocardial infarction, researchers reported ORs of 2.97(2.47, 3.56) for those with heart failure and ORs of 1.61(1.36; 1.93) for those with arrhythmias as compared to patients without these conditions. 15 …”