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JACC March 27, 2012

Volume 59, Issue 13

Acute Coronary Syndromes

INCIDENCE RATES OF DEATH AND MAJOR CARDIOVASCULAR EVENTS AMONG HOSPITALIZED PATIENTS
WITH ACUTE CORONARY SYNDROME - AN ANALYSIS OF A NATIONAL REPRESENTATIVE MEDICARE
POPULATION
ACC Moderated Poster Contributions
McCormick Place South, Hall A
Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.

Session Title: Acute Coronary Syndromes: Basic I

Abstract Category: 6. Acute Coronary Syndromes: Basic
Presentation Number: 1175-512
Authors: Concetta Crivera, Shih-Yin Chen, Michael Stokes, Luke Boulanger, Jeffrey Schein, Janssen Scientific Affairs , LLC, Raritan, NJ, USA
Background: To evaluate the incidence of death and major cardiovascular (CV) events following an initial acute coronary syndrome (ACS)
hospitalization in a national representative Medicare population.
Methods: Data from Medicare Current Beneficiary Survey with Medicare claims were analyzed. Patients with an incident hospitalization for
ACS without similar events during 6 months prior were included. Outcomes evaluated included subsequent CV and stroke events identified from
subsequent hospitalizations with associated diagnosis and mortality determined from hospital discharge status (actual date available) or from
survey (reported monthly). Inpatient mortality rate and incidence of death from admission to loss of follow-up were reported. Among those who
survived and were discharged, incidence rates for death, all-cause readmission, and CV and stroke events were calculated; 30-day readmission and
mortality rates were estimated. Population weights were applied to yield national representative estimates.
Results: Between 03/01/2002- 12/31/ 2006, we identified 795 incident ACS patients (mean age 76 years; 49% male) representing 2,542,211
Medicare beneficiaries. The incidence rates of all cause, myocardial infarction (MI), non-ST elevated MI, ST-elevated MI, ischemic stroke, and
cardiovascular disease hospital readmissions were 906, 144, 87, 63, 48, and 847 per 1000 person-years. Incidence rates of mortality and post
discharge mortality were 309 and 197 per 1000 person-years. Inpatient mortality rate was 9.7%. The 30-day mortality was estimated to be ranging
from 11.0% to 13.9%. Among those who survived, the 30-day readmission rate was 18.6% for all-cause and 17.9% for CV-related.
Conclusions: Short-term (inpatient and 30-day) risk was high for this Medicare-insured population after hospitalization for ACS. Significant longterm risk for death and major CV events remained after discharge. The continuous burden underscores the importance of long-term use of evidencebased therapies to improve outcomes.