Health outcomes after myocardial infarction: A population study of 56 million people in England

by Marlous Hall, Lesley Smith, Jianhua Wu, Chris Hayward, Jonathan A. Batty, Paul C. Lambert, Harry Hemingway, Chris P. Gale

Background

The occurrence of a range of health outcomes following myocardial infarction (MI) is unknown. Therefore, this study aimed to determine the long-term risk of major health outcomes following MI and generate sociodemographic stratified risk charts in order to inform care recommendations in the post-MI period and underpin shared decision making.

Methods and findings

This nationwide cohort study includes all individuals aged ≥18 years admitted to one of 229 National Health Service (NHS) Trusts in England between 1 January 2008and 31 January 2017 (final follow-up 27 March 2017). We analysed 11 non-fatal health outcomes (subsequent MI andfirst hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus, dementia, depression, and cancer) and all-cause mortality. Of the 55,619,430 population of England, 34,116,257 individuals contributing to 145,912,852 hospitalisations were included (mean age 41.7 years (standarddeviation [SD 26.1] ); n = 14,747,198 (44.2%) male). There were 433,361 individualswithMI (mean age 67.4 years [SD 14.4)] ; n = 283,742 (65.5%) male). Following MI, all-cause mortality was the most frequent event (adjusted cumulative incidence at 9 years 37.8% (95% confidence interval [CI] [37.6,37.9] ), followed byheartfailure (29.6%; 95% CI [29.4,29.7] ), renal failure (27.2%; 95% CI [27.0,27.4] ), atrial fibrillation (22.3%; 95% CI [22.2,22.5] ), severe bleeding (19.0%; 95% CI [18.8,19.1] ), diabetes (17.0%; 95% CI [16.9,17.1] ), cancer (13.5%; 95% CI [13.3,13.6] ), cerebrovascular disease (12.5%; 95% CI [12.4,12.7] ), depression (8.9%; 95% CI [8.7,9.0] ), dementia (7.8%; 95% CI [7.7,7.9] ), subsequent MI (7.1%; 95% CI [7.0,7.2] ),andperipheral arterial disease (6.5%; 95% CI [6.4,6.6] ). Comparedwith a risk-set matched population of 2,001,310 individuals, firsthospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (adjusted hazard ratio [aHR] 1.01; 95% CI [0.99,1.02] ;p = 0.468)andcancer (aHR 0.56; 95% CI [0.56,0.57] ;p Conclusions

In this study, up to a third of patients with MI developed heart failure or renal failure, 7% had another MI, and 38% died within 9 years (compared with 35% deaths among matched individuals). The incidence of all health outcomes, except dementia and cancer, was higher than expected during the normal life course without MI following adjustment for age, sex, year, and socioeconomic deprivation. Efforts targeted to prevent or limit the accrual of chronic, multisystem disease states following MI are needed and should be guided by the demographic-specific risk charts derived in this study.

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