Projects per year
Abstract
Objectives: Estimate survival after acute myocardial infarction (AMI) in the general population aged 60 and over, and the effect of recommended treatments.
Design: Cohort study in the United Kingdom with routinely collected data between January 1987 and March 2011.
Setting: 310 general practices that contributed to The Health Improvement Network (THIN) database.
Participants: Four cohorts who reached the age of 60, 65, 70, or 75 years between 1987 and 2011 included 16,744, 43,528, 73,728, and 76,392 participants, respectively. Participants with a history of AMI were matched on sex, year of birth, and general practice to three controls each.
Outcome measures: The hazard of all-cause mortality associated with AMI was calculated by a multilevel Cox’s proportional hazards regression, adjusted for sex, year of birth, socioeconomic status, angina, heart failure, other cardiovascular conditions, chronic kidney disease, diabetes, hypertension, hypercholesterolaemia, alcohol consumption, body mass index, smoking status, coronary revascularisation, prescription of beta blockers, ACE inhibitors, calcium-channel blockers, aspirin, or statins, and general practice.
Results: Compared to no history of AMI by age 60, 65, 70, or 75, having had one AMI was associated with an adjusted hazard of mortality of 1.80 (95% CI 1.60-2.02), 1.71 (1.59-1.84), 1.50 (1.42-1.59), or 1.45 (1.38-1.53), respectively, and having had multiple AMIs with a hazard of 1.92 (1.60-2.29), 1.87 (1.68-2.07), 1.66 (1.53-1.80), or 1.63 (1.51-1.76), respectively. Survival was better after statins (hazard ratio range across the four cohorts 0.74-0.81), beta blockers (0.79-0.85), or coronary revascularisation (in first five years) (0.72-0.80); unchanged after calcium-channel blockers (1.00-1.07); and worse after aspirin (1.05-1.10) or ACE inhibitors (1.10-1.25).
Conclusions: The hazard of death after AMI is less than reported by previous studies, and standard treatments of aspirin or ACE inhibitors prescription may be of little benefit or even cause harm.
Design: Cohort study in the United Kingdom with routinely collected data between January 1987 and March 2011.
Setting: 310 general practices that contributed to The Health Improvement Network (THIN) database.
Participants: Four cohorts who reached the age of 60, 65, 70, or 75 years between 1987 and 2011 included 16,744, 43,528, 73,728, and 76,392 participants, respectively. Participants with a history of AMI were matched on sex, year of birth, and general practice to three controls each.
Outcome measures: The hazard of all-cause mortality associated with AMI was calculated by a multilevel Cox’s proportional hazards regression, adjusted for sex, year of birth, socioeconomic status, angina, heart failure, other cardiovascular conditions, chronic kidney disease, diabetes, hypertension, hypercholesterolaemia, alcohol consumption, body mass index, smoking status, coronary revascularisation, prescription of beta blockers, ACE inhibitors, calcium-channel blockers, aspirin, or statins, and general practice.
Results: Compared to no history of AMI by age 60, 65, 70, or 75, having had one AMI was associated with an adjusted hazard of mortality of 1.80 (95% CI 1.60-2.02), 1.71 (1.59-1.84), 1.50 (1.42-1.59), or 1.45 (1.38-1.53), respectively, and having had multiple AMIs with a hazard of 1.92 (1.60-2.29), 1.87 (1.68-2.07), 1.66 (1.53-1.80), or 1.63 (1.51-1.76), respectively. Survival was better after statins (hazard ratio range across the four cohorts 0.74-0.81), beta blockers (0.79-0.85), or coronary revascularisation (in first five years) (0.72-0.80); unchanged after calcium-channel blockers (1.00-1.07); and worse after aspirin (1.05-1.10) or ACE inhibitors (1.10-1.25).
Conclusions: The hazard of death after AMI is less than reported by previous studies, and standard treatments of aspirin or ACE inhibitors prescription may be of little benefit or even cause harm.
| Original language | English |
|---|---|
| Article number | e013570 |
| Journal | BMJ Open |
| Volume | 7 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Jan 2017 |
Access to Document
- e013570
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Profiles
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Elena Kulinskaya
- School of Computing Sciences - Emeritus Professor
- Norwich Epidemiology Centre - Member
Person: Honorary, Research Group Member
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Nicholas Steel
- Norwich Medical School - Clinical Professor in Public Health
- Norwich Institute for Healthy Aging - Member
- Population Health - Member
- Health Services and Primary Care - Member
Person: Research Group Member, Research Centre Member, Academic, Teaching & Research
Projects
- 1 Finished
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The UEA Small RNA Workbench: New and improved tools or high throughput small RNA analysis
Moulton, V., Dalmay, T. & Smith, R.
Biotechnology and Biological Sciences Research Council
17/07/14 → 16/03/18
Project: Research