TY - JOUR T1 - Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Li Liu A1 - Michael P Jones A1 - Kaskie, Brian A1 - Jason Hockenberry A1 - Elizabeth A Chrischilles A1 - Kara B Wright A1 - John F Geweke A1 - Maksym Obrizan A1 - Robert L. Ohsfeldt A1 - Gary E Rosenthal A1 - Robert B Wallace KW - Aged KW - Educational Status KW - Female KW - Hospitalization KW - Humans KW - Male KW - Marital Status KW - Medicare KW - Myocardial Infarction KW - Patient Discharge KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Sex Factors KW - United States AB -

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8%) suffered postbaseline heart attacks, with 423 participants (7.7%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

PB - 65 VL - 65 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20106961?dopt=Abstract U2 - PMC2904597 U4 - HOSPITALIZATION/heart disease/risk Factors/Medicare/Public Policy ER -