1
|
Mishra V, Desai R, Chhina AK, Raina J, Itare V, Patel M, Doshi R, Gangani K, Sachdeva R, Kumar G. Cardiovascular disease risk factors and outcomes of acute myocardial infarction in young adults in two nationwide cohorts in the united states. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Acute myocardial infarction (AMI) can have considerable morbidity and devastating socioeconomic and psychological consequences in young adults. Previous studies reveal that the decline in mortality in AMI has mainly been in the older population while being comparatively less significant in younger patients. This study compares young adults (18 to 44 years) hospitalized with AMI across two nationwide cohorts, 2007 and 2017, in the United States (US). It examines the burden of AMI hospitalizations, the prevalence of comorbidities, and in-hospital outcomes in young adults a decade apart. It highlights the rise in AMI hospitalizations, lack of decrease in mortality, sex-based and racial disparities, the surge in post-MI complications, and the decline in reperfusion interventions in young AMI patients over a decade.
Purpose
Coronary heart disease prevalence is challenging to ascertain in younger adults because of limited data and frequent silent clinical presentations. AMI and its complications can cause considerable morbidity, psychological trauma, and socioeconomic burden in the young.
Methods
We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample (NIS), which covers 20% of stratified data of all non-federal community hospitals in the US. We compared the following data between the two cohorts: admission rates, sociodemographic features, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the two cohorts. We used Pearson’s Chi-square test and Mann-Whitney U test to compare categorical and continuous variables, respectively. We also applied multivariable regression analyses to assess and compare the risk of cardiovascular complications and in-hospital mortality while controlling for confounders, including age, sex, race, median household income quartile, primary insurance enrolment, and pre-existing comorbidities.
Results
AMI’s incidence was higher in males in both the cohorts, although with a decline (71.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort (Table 1). We found no significant difference in all-cause mortality (aOR = 1.01 (0.93-1.10), p=0.749). Post-AMI complications, cardiogenic shock (aOR = 1.16 (1.06-1.27), p=0.001), and fatal arrhythmias increased. Reperfusion interventions decreased in the 2017 cohort (PCI; aOR=0.95 (0.91-0.98), p<0.001; CABG; aOR=0.66 (0.61-0.71), p<0.001) (Table 2).
Conclusion
Our study highlights the rise in AMI hospitalizations, plateauing of mortality, gender disparity, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over a decade.
Collapse
Affiliation(s)
- V Mishra
- Sir JJ Group of Hospitals, Mumbai, India
| | - R Desai
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - AK Chhina
- Washington D.C. Va Medical Center, Washington, DC, United States of America
| | - J Raina
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - V Itare
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - M Patel
- Smt. BK Shah Medical Institute and Research Centre, Medicine, Vadodara, India
| | - R Doshi
- St Joseph’s Regional Medical Center, Paterson, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Internal Medicine, Arlington, Texas, USA
| | - R Sachdeva
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| |
Collapse
|
2
|
Zebic L, Ezzeldin M, Patel VS, Chhina A, Nijran E, Cheung V, Banerjee A. The record and delivery of caries prevention for children in a primary care setting: a multi-practice collaborative clinical audit. Br Dent J 2019; 224:809-814. [PMID: 29795500 DOI: 10.1038/sj.bdj.2018.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/09/2022]
Affiliation(s)
- L Zebic
- Guy's Hospital, London, SE1 9RT, UK
| | - M Ezzeldin
- University Dental Hospital, Heath Park, Cardiff, CF14 4XY
| | - V S Patel
- Carpenders Park Dental Practice, London, WD19 5BL, UK
| | - A Chhina
- Tewkesbury House Dental Practice, Gloucester, GL20 5PR, UK
| | - E Nijran
- Edgbaston Dental Centre, Birmingham, B5 7NX, UK
| | - V Cheung
- New Road Dental Practice, Bromsgrove, B60 2LA, UK
| | - A Banerjee
- King's College London Dental Institute at Guy's Hospital, Kings' Health Partners, London, SE1 9RT, UK
| |
Collapse
|