National Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> There are few data characterizing temporal changes in hospitalization for recurrent acute myocardial infarction ( <jats:styled-content style="fixed-case">AMI</jats:styled-content> ) after <jats:styled-content style="fixed-case">AMI</jats:styled-content> . </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Using a national sample of 2 305 441 Medicare beneficiaries hospitalized for <jats:styled-content style="fixed-case">AMI</jats:styled-content> from 1999 to 2010, we evaluated changes in the incidence of 1‐year recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> hospitalization and mortality using Cox proportional hazards models. The observed recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> hospitalization rate declined from 12.1% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 11.9 to 12.2) in 1999 to 8.9% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 8.8 to 9.1) in 2010, a relative decline of 26.4%. The observed recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> hospitalization rate declined by a relative 27.7% in whites, from 11.9% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 11.8 to 12.1) to 8.6% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 8.5 to 8.8) versus a relative decline in blacks of 13.6% from 13.2% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 12.6 to 13.8) to 11.4% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 10.9 to 12.0). The risk‐adjusted rate of annual decline in recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> hospitalizations was 4.1% ( <jats:styled-content style="fixed-case">HR</jats:styled-content> 0.959; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.958 to 0.961), and whites experienced a higher rate of decline ( <jats:styled-content style="fixed-case">HR</jats:styled-content> 0.957, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.956 to 0.959) than blacks ( <jats:styled-content style="fixed-case">HR</jats:styled-content> 0.974, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.970 to 0.979).The overall, observed 1‐year mortality rate after hospitalization for recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> declined from 32.4% in 1999 to 29.7% in 2010, a relative decline of 8.3% ( <jats:italic>P</jats:italic> <0.05). In adjusted analyses, 1‐year mortality after recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> hospitalization declined 1.8% per year ( <jats:styled-content style="fixed-case">HR</jats:styled-content> , 0.982; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.980 to 0.985). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> In a national sample of Medicare beneficiaries hospitalized for <jats:styled-content style="fixed-case">AMI</jats:styled-content> from 1999 to 2010, hospitalization for recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> decreased, as did subsequent mortality, albeit to a lesser extent. The risk of recurrent <jats:styled-content style="fixed-case">AMI</jats:styled-content> hospitalization declined less in black patients than in whites, increasing observed racial disparities by the end of the study period. </jats:p> </jats:sec>