Drivers of 1-year mortality decline after acute myocardial infarction in England and Wales: a 15-year national cohort study
Authors' conclusion
One-year survival after AMI improved substantially over 15 years in England and Wales largely due to advances in pharmacotherapy and PCI. Nevertheless, about one-third of the mortality decline remains unexplained, underscoring the need to investigate other contributors such as postdischarge care and health system factors.
Study context
- Population
- Adult patients admitted with acute myocardial infarction (AMI) across England and Wales between 2005 and 2019adult patients admitted with AMI
- Participants
- 852,914 patients
- Exposure
- Changes in 1-year all-cause mortality between 2005 and 2019 and the contribution of clinical, treatment and demographic factors
- Outcome
- 1-year all-cause mortality
- Follow-up
- 2005 to 2019
Methodological detailsnational registry data, decomposition analysis
- National registry data
- Decomposition analysis
Main finding
As reported in the abstract
2005
22.8%
95% CI 22.4% to 23.2%
2019
14.2%
95% CI 13.7% to 14.7%
Absolute reduction
8.6 percentage points
Observational data: associations, not effects.
Further findings
Share of decline explained by measured factors
- Explained by measured factors
- ≈68.2%
Contribution of increased use of evidence-based pharmacological therapies (statins, beta blockers, ACE inhibitors)
- Share of reduction (greatest contributor)
- 27.7% (95% CI 26.0% to 29.5%)
Contribution of increased use of percutaneous coronary intervention (PCI)
- Share of reduction
- 17.6% (95% CI 16.3% to 19.0%)
Mortality by subgroup (ST-elevation myocardial infarction (STEMI), non-STEMI, older adults, women)
- Mortality improvements observed in both STEMI and non-STEMI populations
- Older adults and women continued to experience higher mortality rates throughout the study period
Original publication
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