Association of treatments for acute myocardial infarction and survival for seven common comorbidity states: a nationwide cohort study.
BACKGROUND
Comorbidity is common and has a substantial negative impact on the prognosis of patients with acute myocardial infarction (AMI). Whilst receipt of guideline-indicated treatment for AMI is associated with improved prognosis, the extent to which comorbidities influence treatment provision its efficacy is unknown. Therefore, we investigated the association between treatment provision for AMI and survival for seven common comorbidities.


METHODS
We used data of 693,388 AMI patients recorded in the Myocardial Ischaemia National Audit Project (MINAP), 2003-2013. We investigated the association between comorbidities and receipt of optimal care for AMI (receipt of all eligible guideline-indicated treatments), and the effect of receipt of optimal care for comorbid AMI patients on long-term survival using flexible parametric survival models.


RESULTS
A total of 412,809 [59.5%] patients with AMI had at least one comorbidity, including hypertension (302,388 [48.7%]), diabetes (122,228 [19.4%]), chronic obstructive pulmonary disease (COPD, 89,221 [14.9%]), cerebrovascular disease (51,883 [8.6%]), chronic heart failure (33,813 [5.6%]), chronic renal failure (31,029 [5.0%]) and peripheral vascular disease (27,627 [4.6%]). Receipt of optimal care was associated with greatest survival benefit for patients without comorbidities (HR 0.53, 95% CI 0.51-0.56) followed by patients with hypertension (HR 0.60, 95% CI 0.58-0.62), diabetes (HR 0.83, 95% CI 0.80-0.87), peripheral vascular disease (HR 0.85, 95% CI 0.79-0.91), renal failure (HR 0.89, 95% CI 0.84-0.94) and COPD (HR 0.90, 95% CI 0.87-0.94). For patients with heart failure and cerebrovascular disease, optimal care for AMI was not associated with improved survival.


CONCLUSIONS
Overall, guideline-indicated care was associated with improved long-term survival. However, this was not the case in AMI patients with concomitant heart failure or cerebrovascular disease. There is therefore a need for novel treatments to improve outcomes for AMI patients with pre-existing heart failure or cerebrovascular disease.
['Yadegarfar|Mohammad E|ME|0000-0002-7200-9763', 'Gale|Chris P|CP|', 'Dondo|Tatendashe B|TB|', 'Wilkinson|Chris G|CG|', 'Cowie|Martin R|MR|', 'Hall|Marlous|M|']
D000208:Acute Disease D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D015897:Comorbidity D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D011379:Prognosis D012307:Risk Factors D016019:Survival Analysis
Acute myocardial infarction Survival Comorbidity Guideline care