Mortality following first-time hospitalization with acute myocardial infarction in Norway, 2001-2014: Time trends, underlying causes and place of death

Abstract

Background Trends on cause-specific mortality following acute myocardial infarction (AMI) are poorly described and no studies have analyzed where do AMI patients die.

We analyzed trends in 28-day and one-year mortality following an incident AMI with focus on changes over time in the underlying cause and place of death.

Methods We identified in the ‘Cardiovascular Disease in Norway’ Project all patients 25+ years, hospitalized with an incident AMI in Norway, 2001–2014. Information on date, underlying cause and place of death was obtained from the Cause of Death Registry.

Results Of 144,473 patients included in the study, 11.4% died within first 28 days. The adjusted 28-day mortality declined by 5.2% per year (ptrend < 0.001).

Of 118,881 patients surviving first 28 days, 10.1% died within one year. The adjusted one-year CVD mortality declined by 6.2% per year (ptrend < 0.001) while non-CVD mortality increased by 1.4% per year (ptrend < 0.001), mainly influenced by increased risk of dying from neoplasms.

We observed a shift over time in the underlying cause of death toward more non-CVD deaths, and in the place of death toward more deaths occurring in nursing homes.

Conclusions We observed a decline in 28-day mortality following an incident AMI hospitalization. One-year CVD mortality declined while one-year risk of dying from non-CVD conditions increased. The resulting shift toward more non-CVD deaths and deaths occurring outside a hospital need to be considered when formulating priorities in treating and preventing adverse events among AMI survivors.