Trends in mortality and heart failure after acute myocardial infarction in Italy from 2001 to 2011

- Nationwide cohort study including data on patients admitted with AMI from 2001 to 2011 at Italian hospitals including 1,110,822 patients.
- From 2001 to 2011, index and 1-year in-hospital mortality rates decreased significantly; fatal re-admission rates remained unchanged over time.
- The occurrence of HF at the index admission was associated with a significant increase in the risk of death and fatal readmissions.
- In a subgroup of optimally-treated low-risk patients mortality rates remained low at any considered time point.

BackgroundUncertainties on long-term outcomes after acute myocardial infarction (AMI) still exist, despite the ongoing progresses in the management of patients with AMI.Aim of the studyOur aim was to appraise both the early prognosis and prognosis at 1-year after discharge of patients hospitalized due to AMI.MethodsThis is a retrospective nationwide cohort study based on data from an administrative database on patients admitted with AMI from 2001 to 2011 in all Italian hospitals sites. Mortality and readmission rates within 30 days, 60 days and 1 year were calculated, as well as re-hospitalizations for all causes and for HF.ResultsA total of 1,110,822 patients were included. Index admission mortality rate (I-MR) and total in-hospital mortality rate (T-MR) at up to 1 year both decreased respectively from 11.34% to 8.99% and from 16.46% to 14.68% in the years 2001 to 2011 (both p < 0.0001), while fatal readmission rate (F-RR) at 1 year increased from 4.75% to 5.28% (p = 0.0019). Patients that developed HF during the index admission had significantly higher I-MR and F-RR. I-MR, F-RR, and T-MR, however, remained low at any time point considered (30 days, 60 days and 1 year) in a subgroup of low-risk optimally-treated patients.ConclusionsThe risk of fatal readmission at 1 year increased slightly over time, in spite of the remarkable improvements currently achieved in overall prognosis after AMI. The identification of patients at high risk (mainly due to HF complicating AMI), and of patients at low risk is crucial to define and support management strategies.