Impact of age, gender and heart failure on mortality trends after acute myocardial infarction in Italy

Background: The outcome of patients with acute myocardial infarction (AMI) may vary substantially based on baseline risk. We aimed at analyzing the impact of gender, age and heart failure (HF) on mortality trends, based on a nationwide, comprehensive and universal administrative database of AMI. Methods: This is a nationwide cohort study of patients admitted with AMI from 2009 to 2018 in all Italian hospitals. In-hospital mortality rate (I-MR) and 1-year post-discharge mortality rate (1-Y-MR) were assessed. Results: Among the 1,000,965 AMI events included in the analysis, 43.6% occurred in patients aged >75 years, 34.7% in females and 21.8% in AMI complicated by HF at the index hospitalization. Both I-MR and 1-Y-MR significantly decreased over time (from 8.87% to 6.72%; mean annual change-0.23%; confidence intervals (CI): 0.26% to-0.20% and from 12.24% to 10.59%; mean annual change-0.18%; CI: 0.24% to-0.13%, respectively). This trend was confirmed in younger and elderly AMI patients, in both sexes. In AMI patients complicated by HF, both I-MR and 1-Y-MR were markedly high, regardless of age and gender. Conclusions: This contemporary, nationwide study suggests that I-MR and 1-Y-MR are still elevated, albeit decreasing over time. Elderly patients and those with HF at the time of index admission, present a particularly high risk of fatal events, regardless of gender.

Automated summary

This nationwide study examines the impact of gender, age, and heart failure on mortality trends in patients with acute myocardial infarction (AMI). The study finds a decrease in both in-hospital mortality rate and 1-year post-discharge mortality rate over time. Elderly patients and those with heart failure were found to have a higher risk of fatal events.