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Original Articles

A 30-Year Perspective (1975–2005) Into the Changing Landscape of Patients Hospitalized With Initial Acute Myocardial Infarction

Worcester Heart Attack Study

Kevin C. Floyd, MD; Jorge Yarzebski, MD, MPH; Frederick A. Spencer, MD; Darleen Lessard, MS; James E. Dalen, MD; Joseph S. Alpert, MD; Joel M. Gore, MD and Robert J. Goldberg, PhD

From the Department of Medicine (K.C.F., J.Y., F.A.S., D.L., J.M.G., R.J.G.), Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass; the Department of Medicine (F.A.S.), McMaster University, Hamilton, Ontario, Canada; and the Department of Medicine (J.E.D., J.S.A.), University of Arizona, School of Health Sciences, Tucson, Ariz.

Correspondence to Robert J. Goldberg, PhD, Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail robert.goldberg{at}umassmed.edu

Received August 1, 2008; accepted December 2, 2008.

Background— The effects of lifestyle changes and evolving treatment practices on coronary disease incidence rates, demographic and clinical profile, and the short-term outcomes of patients hospitalized with acute myocardial infarction have not been well characterized. The purpose of this study was to examine multidecade-long trends (1975–2005) in the incidence rates, demographic and clinical characteristics, treatment practices, and hospital outcomes of patients hospitalized with an initial acute myocardial infarction from a population-based perspective.

Methods and Results— Residents of the Worcester, Mass, metropolitan area (median age, 37 years; 89% white) hospitalized with an initial acute myocardial infarction (n=8898) at all greater-Worcester medical centers during 15 annual periods between 1975 and 2005 comprised the sample of interest. The incidence rates of initial acute myocardial infarction were lower in 2005 (209 of 100 000 population) than in 1975 (277 of 100 000), although these trends varied inconsistently over time. Patients hospitalized during the most recent study years were significantly older (mean age, 64 years in 1975; 71 years in 2005), more likely to be women (38% in 1975; 48% in 2005), and have a greater prevalence of comorbidities. Hospitalized patients were increasingly more likely to receive effective cardiac medications and coronary interventional procedures for the period under investigation. Hospital survival rates improved significantly over time (81% survived in 1975; 91% survived in 2005), although varying trends were observed in the occurrence of clinically important complications.

Conclusions— The results of this community-wide investigation provide insight into the changing magnitude, characteristics, management practices, and outcomes of patients hospitalized with a first myocardial infarction.

Key Words: acute myocardial infarction • community-wide trends • surveillance

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CLINICAL PERSPECTIVE

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