London, UK—
Fewer heart-attack survivors are experiencing recurrence in recent years, but rates—and unfavorable outcomes—remain too high, according to a new report.

An article in the journal Circulation discusses that, despite a decline in a second acute myocardial infarction (AMI) between 2008 and 2017, especially among women, the rate of recurrent AMIs, hospitalization for heart failure, and death remains unacceptably high.

“Secondary events after a heart attack may be prevented by ensuring that patients receive guideline-recommended treatments to lower the risk for recurrent heart disease and death after hospital discharge,” advised lead author Sanne A. E. Peters, PhD, senior lecturer at The George Institute for Global Health in collaboration with Imperial College London, United Kingdom.

The report also emphasized that sex differences persist, despite the drops, and that men have higher rates of recurrent coronary disease events and death, while women have higher rates of heart-failure hospitalization. “Efforts to further lower these rates should focus on improvements in the implementation of guideline-directed recommendations following MI, including medical therapies,” the authors write. “Although high-intensity statins and antihypertensive medications reduce the risk of recurrent events, and generic versions are available, the use of these therapies remains suboptimal and many high-risk patients do not initiate or continue taking guideline-recommended treatments.”

For example, the study points out that women continue to be less likely than men to fill a prescription for high-intensity statins following hospitalization for myocardial infarction (MI), “suggesting that interventions to improve medication use may have to be sex-specific. In addition to patient characteristics, quality improvement programs should focus on health systems and consider regional variation, as there are substantial disparities across regions in the use of guideline-directed medical therapy,” the researchers point out.

Data for the study came from MarketScan and Medicare. Included were 770,408 women and 700,477 men younger than age 65 years in the United States  with commercial health insurance, as well as a cohort aged 66 years and older with government health insurance through Medicare. Participants all had a history of MI hospitalization between 2008 and 2017 and were followed for recurrent MI, coronary revascularization, heart failure hospitalization, and all-cause mortality (Medicare only) in the 365 days after the initial event.

The researchers determined that, from 2008 to 2017, age-standardized recurrent MI rates per 1,000 person-years decreased from 89.2 to 72.3 in women and from 94.2 to 81.3 in men (multivariable-adjusted P-interaction by sex <.001). At the same time, recurrent coronary heart disease event rates decreased from 166.3 to 133.3 in women and from 198.1 to 176.8 in men (P-interaction <.001).

In addition, heart failure hospitalization rates decreased from 177.4 to 158.1 in women and from 162.9 to 156.1 in men (P-interaction = .001, while all-cause mortality rates decreased from 403.2 to 389.5 in women and from 436.1 to 417.9 in men (P-interaction = .82).

In 2017, the multivariable-adjusted rate ratios (95%CI), comparing women with men were 0.90 (0.86, 0.93) for recurrent MI, 0.80 (0.78, 0.82) for recurrent coronary heart disease (CHD) events, 0.99 (0.96, 1.01) for heart failure hospitalization, and 0.82 (0.80-0.83) for all-cause mortality, the authors advised.

“Rates of recurrent MI, recurrent CHD events, heart failure hospitalization, and mortality in the first year after an MI declined considerably between 2008 and 2017 in both men and women, with proportionally greater reductions for women than men,” the researchers conclude. “However, rates remain very high and rates of recurrent MI, recurrent CHD events and death continue to be higher among men than women.”
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