Dr. Emily B. Levitan, associate professor in the department of epidemiology at the University of Alabama at Birmingham, recently compared the characteristics and prognosis of acute myocardial infarctions (AMIs) that were not the primary reason for hospitalization, and thus not primary discharge diagnosis, to AMIs that were the primary reason for hospitalization. UAB co-investigators are department colleagues Dr. Paul Muntner, professor and vice chair, and statisticians Mr. Christopher M. Gamboa and Dr. Luqin Deng; as well as J. David Rhodes, program director in the department of biostatistics; Dr. Todd M. Brown, assistant professor in the division of cardiovascular disease; and Dr. Monika M. Safford, professor in the division of preventive medicine.
[Photo: Dr. Emily B. Levitan]
Primary discharge diagnoses for REasons for Geographic And Racial Differences in Stroke (REGARDS) participants (Black and White men and women ages 45 years and older) with adjudicated AMIs were categorized as “AMI” or “other.” Cox models were used to compare mortality up to five years post-AMI between primary discharge diagnoses of AMI and other.
Dr. Levitan and her fellow researchers found that of 871 AMIs, primary discharge diagnosis was not AMI in 550 (63 percent). When primary discharge diagnosis was not AMI, average troponin elevations were smaller and heart failure was more common. Adjusted for participant and hospitalization characteristics, all-cause, coronary heart disease, and cardiovascular disease mortality following AMI were similar between groups (hazard ratios, 95 percent confidence intervals 1.08, 0.80-1.47; 1.29, 0.76-2.18; and 0.86, 0.58-1.27, respectively).
The team concluded that studies limited to individuals with primary discharge diagnosis of AMI may underestimate the burden of AMI and exclude a group with elevated risk of all-cause, coronary heart disease and cardiovascular disease mortality.
“Characteristics and Prognosis of Acute Myocardial Infarction by Discharge Diagnosis: The REasons for Geographic And Racial Differences in Stroke Study” was published in February 2015 in the Annals of Epidemiology.