Trends in hospital discharges, management and in-hospital mortality from acute myocardial infarction in Switzerland between 1998 and 2008

Charlène Insam, Fred Paccaud, Pedro Marques-Vidal, Charlène Insam, Fred Paccaud, Pedro Marques-Vidal

Abstract

Background: Since the late nineties, no study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland. Our objective was to fill this gap.

Methods: Swiss hospital discharge database for years 1998 to 2008. AMI was defined as a primary discharge diagnosis code I21 according to the ICD10 classification. Invasive treatments and overall in-hospital mortality were assessed.

Results: Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The percentage of hospitalizations with a stay in an Intensive Care Unit decreased from 38.0% in 1998 to 36.2% in 2008 (p for trend < 0.001). Percutaneous revascularizations increased from 6.0% to 39.9% (p for trend < 0.001). Bare stents rose from 1.3% to 16.6% (p for trend < 0.001). Drug eluting stents appeared in 2004 and increased to 23.5% in 2008 (p for trend < 0.001). Coronary artery bypass graft increased from 1.0% to 3.0% (p for trend < 0.001). Circulatory assistance increased from 0.2% to 1.7% (p for trend < 0.001). Among patients managed in a single hospital (not transferred), seven-day and total in-hospital mortality decreased from 8.0% to 7.0% (p for trend < 0.01) and from 11.2% to 10.1%, respectively. These changes were no longer significant after multivariate adjustment for age, gender, region, revascularization procedures and transfer type. After multivariate adjustment, differing trends in revascularization procedures and in in-hospital mortality were found according to the geographical region considered.

Conclusion: In Switzerland, a steep rise in hospital discharges and in revascularization procedures for AMI occurred between 1998 and 2008. The increase in revascularization procedures could explain the decrease in in-hospital mortality rates.

Figures

Figure 1
Figure 1
Number of patients discharged with a main diagnosis of acute myocardial infarction who were managed in a single hospital (in-house), in Switzerland and by region, 1998–2008.
Figure 2
Figure 2
Number of patients with a main diagnosis of acute myocardial infarction who were admitted from another hospital and managed on-site (inbound), in Switzerland and by region, 1998–2008.
Figure 3
Figure 3
Number of patients with a main diagnosis of acute myocardial infarction who were managed on-site and transferred to another hospital (outbound), in Switzerland and by region, 1998–2008.
Figure 4
Figure 4
Number of patients with a main diagnosis of acute myocardial admitted from another hospital and transferred to another hospital (passing through), in Switzerland and by region, 1998–2008.
Figure 5
Figure 5
Trends in intensive care unit (ICU) utilization for acute myocardial infarction in Switzerland, overall and by region, for the period 1998–2008. Results are expressed as percentage of hospital discharges with a diagnosis of acute myocardial infarction.
Figure 6
Figure 6
Trends in the use of drug-eluting and non-drug-eluting stents for acute myocardial infarction in Switzerland, overall and by region, for the period 1998–2008. Results are expressed as percentage of hospital discharges with a diagnosis of acute myocardial infarction.
Figure 7
Figure 7
Trends in the use of coronary artery bypass graft (CABG) for acute myocardial infarction in Switzerland, overall and by region, for the period 1998–2008. Results are expressed as percentage of hospital discharges with a diagnosis of acute myocardial infarction.
Figure 8
Figure 8
Trends in seven-day in-hospital mortality rates from acute myocardial infarction in Switzerland, overall and by region, for the period 1998–2008. Results are expressed as percentage of patients inbound or in-house discharged with a diagnosis of acute myocardial infarction.
Figure 9
Figure 9
Trends in overall in-hospital mortality rates from acute myocardial infarction in Switzerland, overall and by region, for the period 1998–2008. Results are expressed as percentage of patients inbound or in-house discharged with a diagnosis of acute myocardial infarction.

References

    1. Müller-Nordhorn J, Binting S, Roll S, Willich SN. An update on regional variation in cardiovascular mortality within Europe. Eur Heart J. 2008;29(10):1316–1326.
    1. Berrut S, Junker C. Statistique de la Suisse. Office Fédéral de la Statistique: Neuchâtel, Switzerland; 2008. D'une génération à l’autre. Evolution des causes de décès de 1970 à 2004; p. 64.
    1. Gerber Y, Rihal CS, Sundt TM, Killian JM, Weston SA 3rd, Therneau TM, Roger VL. Coronary revascularization in the community. A population-based study, 1990 to 2004. J Am Coll Cardiol. 2007;50(13):1223–1229. doi: 10.1016/j.jacc.2007.06.022.
    1. Goldberg RJ, Spencer FA, Okolo J, Lessard D, Yarzebski J, Gore JM. Long-term trends in the use of coronary reperfusion strategies in acute myocardial infarction: a community-wide perspective. J Thromb Thrombolysis. 2007;23(3):163–171. doi: 10.1007/s11239-006-9029-0.
    1. Hahn J, Lessard D, Yarzebski J, Goldberg J, Pruell S, Spencer FA, Gore JM, Goldberg RJ. A community-wide perspective into changing trends in the utilization of diagnostic and interventional procedures in patients hospitalized with acute myocardial infarction. American Heart Journal. 2007;153(4):594–605. doi: 10.1016/j.ahj.2007.01.034.
    1. Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001–2008. Jama. 2011;305(17):1769–1776. doi: 10.1001/jama.2011.551.
    1. Collart P, Coppieters Y, Leveque A. Trends in acute myocardial infarction treatment between 1998 and 2007 in a Belgian area (Charleroi) Eur J Cardiovasc Prev Rehabil. 2012;19(4):738–745.
    1. Fassa AA, Urban P, Radovanovic D, Duvoisin N, Gaspoz JM, Stauffer JC, Erne P. Evolution du traitement de reperfusion de l’infarctus du myocarde avec sus-décalage du segment ST en Suisse de 1997 à 2005. [Temporal trends in treatment of ST segment elevation myocardial infarction in Switzerland from 1997 to 2005] Rev Med Suisse. 2006;2(67):1393–1396, 1398.
    1. Kolh P, Wijns W. Joint ESC/EACTS guidelines on myocardial revascularization. J Cardiovasc Med (Hagerstown) 2011;12(4):264–267. doi: 10.2459/JCM.0b013e328344e647.
    1. Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54(23):2205–2241. doi: 10.1016/j.jacc.2009.10.015.
    1. Office Fédéral de la Statistique (Federal Office for Statistics) Medizinische Statistik der Krankenhäuser 2009 – Standardtabellen. Statistique médicale des hôpitaux 2009 – tableaux standard. [Hospital statistics 2009 - standard results] Neuchâtel, Switzerland: Département fédéral de l’intérieur DFI; 2011. p. 68.
    1. Hungerbühler P, Wietlisbach V, Rickenbach M, Vogt P. Evolution du traitement de l'infarctus du myocarde en Suisse de 1986 à 1990: les résultats d'une étude de population. [Developments in the treatment of myocardial infarction in Switzerland 1986–1990: results of a population survey] Schweiz Med Wochenschr. 1992;122(50):1919–1926.
    1. Gothuey JM, Wietlisbach V, Rickenbach M, Barazzoni F, la Vecchia C. Fréquence d’utilisation des différents traitements de l’infarctus du myocarde dans deux régions suisses. [Incidence of use of various myocardial infarct treatments in 2 Swiss regions] Sozial- und Praventivmedizin. 1991;36(6):333–340. doi: 10.1007/BF01368741.
    1. Gogo PB Jr, Dauerman HL, Mulgund J, Ohman EM, Patel MR, Cohen DJ, Saucedo JF, Harrington RA, Gibler WB, Smith SC Jr. Changes in patterns of coronary revascularization strategies for patients with acute coronary syndromes (from the CRUSADE Quality Improvement Initiative) American Journal of Cardiology. 2007;99(9):1222–1226. doi: 10.1016/j.amjcard.2006.12.037.
    1. Moschovitis A, Cook S, Meier B. Percutaneous coronary interventions in Europe in 2006. Euro Intervention. 2010;6(2):189–194.
    1. Stolt Steiger V, Goy JJ, Stauffer JC, Radovanovic D, Duvoisin N, Urban P, Bertel O, Erne P. Significant decrease in in-hospital mortality and major adverse cardiac events in Swiss STEMI patients between 2000 and December 2007. Swiss Med Wkly. 2009;139(31–32):453–457.
    1. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362(23):2155–2165. doi: 10.1056/NEJMoa0908610.
    1. Nedkoff LJ, Briffa TG, Preen DB, Sanfilippo FM, Hung J, Ridout SC, Knuiman M, Hobbs M. Age- and sex-specific trends in the incidence of hospitalized acute coronary syndromes in Western Australia. Circ Cardiovasc Qual Outcomes. 2011;4(5):557–564. doi: 10.1161/CIRCOUTCOMES.110.960005.
    1. Madsen M, Davidsen M, Rasmussen S, Abildstrom SZ, Osler M. The validity of the diagnosis of acute myocardial infarction in routine statistics: a comparison of mortality and hospital discharge data with the Danish MONICA registry. J Clin Epidemiol. 2003;56(2):124–130. doi: 10.1016/S0895-4356(02)00591-7.
    1. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined–a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36(3):959–969. doi: 10.1016/S0735-1097(00)00804-4.
    1. Ferguson JL, Beckett GJ, Stoddart M, Walker SW, Fox KA. Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin, increases the apparent incidence of infarction. Heart. 2002;88(4):343–347. doi: 10.1136/heart.88.4.343.
    1. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2011.
    1. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909–2945.
    1. Bramkamp M, Radovanovic D, Erne P, Szucs TD. Determinants of costs and the length of stay in acute coronary syndromes: a real life analysis of more than 10,000 patients. Cardiovasc Drugs Ther. 2007;21(5):389–398. doi: 10.1007/s10557-007-6044-0.
    1. Health care system costs as percentage of GDP. .
    1. Austin D, Oldroyd KG, Holmes DR Jr, Rihal CS, Galbraith PD, Ghali WA, Legrand V, Taeymans Y, McConnachie A, Pell JP. Drug-eluting stents: a study of international practice. American Heart Journal. 2009;158(4):576–584. doi: 10.1016/j.ahj.2009.07.033.
    1. Thomas M. Are drug eluting stents really worth the money? Heart. 2006;92(1):5–7. doi: 10.1136/hrt.2005.066316.
    1. Bagust A, Grayson AD, Palmer ND, Perry RA, Walley T. Cost effectiveness of drug eluting coronary artery stenting in a UK setting: cost-utility study. Heart. 2006;92(1):68–74. doi: 10.1136/hrt.2004.053850.
    1. Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation. 2007;115(11):1440–1455. doi: 10.1161/CIRCULATIONAHA.106.666800. discussion 1455.
    1. Nordmann AJ, Briel M, Bucher HC. Mortality in randomized controlled trials comparing drug-eluting vs. bare metal stents in coronary artery disease: a meta-analysis. Eur Heart J. 2006;27(23):2784–2814. doi: 10.1093/eurheartj/ehl282.
    1. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997–2007. BMC Public Health. 2011;11:114. doi: 10.1186/1471-2458-11-114.
    1. Cubbon RM, Wheatcroft SB, Grant PJ, Gale CP, Barth JH, Sapsford RJ, Ajjan R, Kearney MT, Hall AS. Temporal trends in mortality of patients with diabetes mellitus suffering acute myocardial infarction: a comparison of over 3000 patients between 1995 and 2003. Eur Heart J. 2007;28(5):540–545.
    1. Zhang Z, Fang J, Gillespie C, Wang G, Hong Y, Yoon PW. Age-specific gender differences in in-hospital mortality by type of acute myocardial infarction. Am J Cardiol. 2012;109(8):1097–1103. doi: 10.1016/j.amjcard.2011.12.001.
    1. Zahger D, Hod H, Gottlieb S, Leor J, Hasdai D, Sandach A, Hammerman H, Behar S. for the ASG. Influence of the new definition of acute myocardial infarction on coronary care unit admission, discharge diagnosis, management and outcome in patients with non-ST elevation acute coronary syndromes: a national survey. Int J Cardiol. 2006;106(2):164–169. doi: 10.1016/j.ijcard.2004.12.082.
    1. Radovanovic D, Erne P. AMIS Plus: Swiss registry of acute coronary syndrome. Heart. 2010;96(12):917–921. doi: 10.1136/hrt.2009.192302.
    1. Merry AH, Boer JM, Schouten LJ, Feskens EJ, Verschuren WM, Gorgels AP, van den Brandt PA. Validity of coronary heart diseases and heart failure based on hospital discharge and mortality data in the Netherlands using the cardiovascular registry Maastricht cohort study. Eur J Epidemiol. 2009;24(5):237–247. doi: 10.1007/s10654-009-9335-x.
    1. Elo SL, Karlberg IH. Validity and utilization of epidemiological data: a study of ischaemic heart disease and coronary risk factors in a local population. Public Health. 2009;123(1):52–57. doi: 10.1016/j.puhe.2008.07.010.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren