Trends in Clinical Characteristics and Outcomes in ST-Elevation Myocardial Infarction Hospitalizations in the United
Keerat Rai Ahuja1, Anas M Saad2, Salik Nazir3
1Department of Cardiovascular Medicine, Reading Hospital Tower Health, West Reading, PA.
Insights
ST-segment Elevation Myocardial Infarction (STEMI) hospitalizations decreased significantly from 2002 to 2016. However, STEMI remains more prevalent in males, white individuals, and those with higher socioeconomic status, with increasing comorbidities.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- ST-segment Elevation Myocardial Infarction (STEMI) represents a critical public health challenge.
- Understanding demographic trends in STEMI hospitalizations is crucial for targeted interventions.
Purpose of the Study:
- To analyze demographic trends in STEMI hospitalizations across the United States over a 15-year period (2002-2016).
- To evaluate changes in treatment patterns and in-hospital mortality among STEMI patients.
Main Methods:
- Utilized the Nationwide Inpatient Sample to identify patients hospitalized with STEMI from 2002 to 2016.
- Calculated annual hospitalization rates and analyzed trends using regression analysis.
- Assessed Percutaneous Coronary Intervention (PCI) rates and in-hospital mortality, stratifying by demographic and socioeconomic factors.
Main Results:
- Total STEMI hospitalizations declined from 421,043 in 2002 to 208,510 in 2016 (P < 0.01).
- PCI rates increased significantly (APC = 5.392%), but remained higher in males, urban settings, and higher SES groups.
- In-hospital mortality decreased slightly (APC = -0.771%) but was higher in females, rural areas, and low SES groups. Comorbidities increased.
- STEMI hospitalizations decreased, but patients with modifiable risk factors are increasing.
Conclusions:
- Despite an overall decline in STEMI hospitalizations, disparities persist among gender, race, and socioeconomic status.
- While PCI utilization and survival have improved, vulnerable populations (females, rural residents, low SES) require focused attention.
- The rising prevalence of comorbidities among STEMI patients necessitates strategies to address modifiable risk factors.
Abstract:
ST-segment Elevation Myocardial Infarction (STEMI) remains a major modern-day public health problem. We aimed to assess the demographic trends in STEMI related hospitalizations in the United States over a period of fifteen years. The nationwide inpatient sample was queried to obtain information of patients hospitalized with STEMI from January 1, 2002, to December 31, 2016. Annual hospitalization rates were calculated and annual percentage change (APC) was evaluated using regression analysis. A total of 4,121,155 eligible patients were included in this analysis. Overall, the total number of STEMI hospitalization decreased from 421,043 in 2002 to 208,510 in 2016 (P-trend <0.01). With the decreasing trend, the rate was relatively higher among males as compared to females, whites as compared to non-whites, and lower as compared to high socioeconomic status (SES). The rate of PCI in STEMI patients increased from 32.8% in 2002 to 67.8% in 2016 (APC = 5.392%, 95% CI [4.384-6.411], P < 0.001), but was higher among males as compared to females, urban as compared to rural hospitals and higher as compared to lower SES. In-hospital mortality decreased from 11% in 2002 to 10.5% in 2016 (APC = -0.771%, 95% CI [-1.230 to -0.311], P = 0.003), but remained higher among females, rural hospitals and low SES as compared to their correspondent groups. Among STEMI patients, the prevalence of individual comorbidities was noted to be increasing over the study period. Although there has been a declining trend in the number of STEMI hospitalizations, patients with modifiable risk factors presenting with STEMI has been on the rise. Females, rural communities and lower SES groups need special attention because of greater vulnerability.
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