Death, long-term nursing home placement, and impoverishment after recurrent myocardial infarction.

Study Objective: To determine whether recurrent myocardial infarction (MI) is associated with increased risk of mortality, long-term nursing home placement, and impoverishment.
Design: Retrospective cohort study.
Setting: United States Medicare program.
Participants: Individuals age > 65 years with recurrent MI hospitalizations ( n  = 228,826) between January 1, 2007 and June 30, 2017 and controls with initial but not recurrent MI ( n  = 915,304).
Main Outcome Measures: Death, nursing home placement, and impoverishment (Medicaid enrollment or subsidies for low-income and -resource individuals) through December 31, 2017.
Results: In the recurrent MI and control cohorts, 47% and 41% of individuals were age > 80 years, respectively, and 56% of both cohorts were women. After 1 year, 48% of the recurrent MI cohort and 16% of the control cohort died, 9% and 7% experienced nursing home placement, and 4% and 2% experienced impoverishment. Multivariable-adjusted hazard ratios (95% confidence intervals) comparing the recurrent MI and control cohorts were 2.04 (2.03-2.06) for death, 0.89 (0.88-0.91) for nursing home placement, and 1.32 (1.28-1.36) for impoverishment.
Conclusions: Older US adults with recurrent MI had higher risk of death and impoverishment than controls who had experienced an initial MI. Unadjusted, recurrent MI was associated with higher risk of nursing home placement; however, after adjusting for sociodemographic characteristics and comorbidities, individuals with recurrent MI had slightly lower risk of nursing home placement. Preventing recurrent MI may also reduce the risk of death and impoverishment among older US adults.
Competing Interests: EBL reports research funding from Amgen and serving as a consultant for a Novartis funded research project. VB reports research funding from Sanofi, AstraZeneca, DalCor, Esperion, and Bayer, and consulting for Sanofi. MMS reports research funding from Amgen. EAJ reports research funding from Amgen and consulting income from McKesson and UpToDate. KLM reports Amgen employment and stock ownership. PM reports research funding from Amgen. The other authors have no interests to report.
(© 2021 The Authors.)