Survival prospects after acute myocardial infarction in the UK: a matched cohort study 1987–2011

Gitsels, Lisanne A, Kulinskaya, Elena and Steel, Nicholas ORCID: (2017) Survival prospects after acute myocardial infarction in the UK: a matched cohort study 1987–2011. BMJ Open, 7 (1). ISSN 2044-6055

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Objectives: Estimate survival after acute myocardial infarction (AMI) in the general population aged 60 and over, and the effect of recommended treatments. Design: Cohort study in the United Kingdom with routinely collected data between January 1987 and March 2011. Setting: 310 general practices that contributed to The Health Improvement Network (THIN) database. Participants: Four cohorts who reached the age of 60, 65, 70, or 75 years between 1987 and 2011 included 16,744, 43,528, 73,728, and 76,392 participants, respectively. Participants with a history of AMI were matched on sex, year of birth, and general practice to three controls each. Outcome measures: The hazard of all-cause mortality associated with AMI was calculated by a multilevel Cox’s proportional hazards regression, adjusted for sex, year of birth, socioeconomic status, angina, heart failure, other cardiovascular conditions, chronic kidney disease, diabetes, hypertension, hypercholesterolaemia, alcohol consumption, body mass index, smoking status, coronary revascularisation, prescription of beta blockers, ACE inhibitors, calcium-channel blockers, aspirin, or statins, and general practice. Results: Compared to no history of AMI by age 60, 65, 70, or 75, having had one AMI was associated with an adjusted hazard of mortality of 1.80 (95% CI 1.60-2.02), 1.71 (1.59-1.84), 1.50 (1.42-1.59), or 1.45 (1.38-1.53), respectively, and having had multiple AMIs with a hazard of 1.92 (1.60-2.29), 1.87 (1.68-2.07), 1.66 (1.53-1.80), or 1.63 (1.51-1.76), respectively. Survival was better after statins (hazard ratio range across the four cohorts 0.74-0.81), beta blockers (0.79-0.85), or coronary revascularisation (in first five years) (0.72-0.80); unchanged after calcium-channel blockers (1.00-1.07); and worse after aspirin (1.05-1.10) or ACE inhibitors (1.10-1.25). Conclusions: The hazard of death after AMI is less than reported by previous studies, and standard treatments of aspirin or ACE inhibitors prescription may be of little benefit or even cause harm.

Item Type: Article
Uncontrolled Keywords: sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School: Faculty of Science > School of Computing Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 23 Dec 2016 00:01
Last Modified: 22 Oct 2022 02:02
DOI: 10.1136/bmjopen-2016-013570

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