Dataset Information

Death, long-term nursing home placement, and impoverishment after recurrent myocardial infarction.

ABSTRACT:

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

Individuals age > 65 years with recurrent MI hospitalizations (n = 228,826) between January 1, 2007 and June 30, 2017 and controls with initial but not recurrent MI (n = 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.

SUBMITTER: Levitan EB

PROVIDER: S-EPMC10978126 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Death, long-term nursing home placement, and impoverishment after recurrent myocardial infarction.

Levitan Emily B EB Poudel Bharat B Huang Lei L Zhao Hong H Bittner Vera V Safford Monika M MM Jackson Elizabeth A EA Monda Keri L KL Muntner Paul P

American heart journal plus : cardiology research and practice 20210730

<h4>Study objective</h4>To determine whether recurrent myocardial infarction (MI) is associated with increased risk of mortality, long-term nursing home placement, and impoverishment.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>United States Medicare program.<h4>Participants</h4>Individuals age > 65 years with recurrent MI hospitalizations (<i>n</i> = 228,826) between January 1, 2007 and June 30, 2017 and controls with initial but not recurrent MI (<i>n</i> = 915,304).<h4>Main outco ...[more]

PMID: 38550653

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Project description:Whole-genome gene expression analysis has been successfully utilized to diagnose, prognosticate, and identify potential therapeutic targets for cardiovascular disease. However, the utility of this approach to identify outcome-related genes and dysregulated pathways following first-time myocardial infarction (AMI) remains unknown and may offer a novel strategy to detect affected expressome networks that predict long-term outcome. Whole-genome microarray and targeted cytokine expression profiling on blood samples from normal cardiac function controls and first-time AMI patients within 48-hours post-MI revealed expected differential gene expression profiles enriched for inflammation and immune-response pathways in AMI patients. To determine molecular signatures at the time of AMI that could prognosticate long-term outcomes, transcriptional profiles from sub-groups of AMI patients with (n=5) or without (n=22) any recurrent events over an 18-month follow-up were compared. This analysis identified 559 differentially expressed genes. Bioinformatic analysis of this differential gene set for associated pathways revealed 1) increasing disease severity in AMI patients is associated with a decreased expression of the developmental epithelial-to-mesenchymal transition, and 2) modulation of cholesterol transport genes that include ABCA1, CETP, APOA1, and LDLR is associated with clinical outcome. In conclusion, differentially regulated genes and modulated pathways were identified that predicted recurrent cardiovascular outcomes in first-time AMI patients. This cell-based approach for risk stratification in AMI warrants a larger study to determine the role of metabolic remodeling and regenerative processes required for optimal outcomes. A validated transcriptome assay could represent a novel, non-invasive platform to anticipate modifiable pathways and therapeutic targets to optimize long-term outcome for AMI patients. The overall experimental design includes blood samples from 21 control and 31 myocardial infaction patient groups. Among the 31patients, 5 patients have recurrent events. Microarray were peformed on the blood samples and comparisons of control vs patient and patients with recurrent events vs patients without recurrent events were performed to identify differential genes related to disease or patients groups with recurrent events for the following bioinformatic analysis.

Dataset Information

Death, long-term nursing home placement, and impoverishment after recurrent myocardial infarction.

Study objective

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Death, long-term nursing home placement, and impoverishment after recurrent myocardial infarction.

Similar Datasets

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