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Excess Mortality and Loss of Life Expectancy After Myocardial Infarction : A Registry-Based Matched Cohort Study

Reitan, Christian ; Andell, Pontus ; Alfredsson, Joakim ; Erlinge, David LU orcid ; Hofmann, Robin ; Lindahl, Bertil ; Simonsson, Moa ; Dickman, Paul W. and Jernberg, Tomas (2024) In Circulation 150(11). p.826-835
Abstract

BACKGROUND: The effect of myocardial infarction (MI) on life expectancy is difficult to study because the prevalence of MI hinders direct comparison with the life expectancy of the general population. We sought to assess this in relation to age, sex, and left ventricular ejection fraction (LVEF) by comparing individuals with MI with matched comparators without previous MI. METHODS: We included patients with a first MI between 1991 and 2022 from the nationwide SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), each matched with up to 5 comparators on age, sex, and region of residence. Flexible parametric survival models were used... (More)

BACKGROUND: The effect of myocardial infarction (MI) on life expectancy is difficult to study because the prevalence of MI hinders direct comparison with the life expectancy of the general population. We sought to assess this in relation to age, sex, and left ventricular ejection fraction (LVEF) by comparing individuals with MI with matched comparators without previous MI. METHODS: We included patients with a first MI between 1991 and 2022 from the nationwide SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), each matched with up to 5 comparators on age, sex, and region of residence. Flexible parametric survival models were used to estimate excess mortality and mean loss of life expectancy (LOLE) depending on index year, age, sex, and LVEF, and adjusted for differences in characteristics. RESULTS: A total of 335 748 cases were matched to 1 625 396 comparators. A higher LOLE was observed in younger individuals, women, and those with reduced LVEF (<50%). In 2022, the unadjusted and adjusted mean LOLE spanned from 11.1 and 9.5 years in 50-year-old women with reduced LVEF to 5 and 3.7 months in 80-year-old men with preserved LVEF. Between 1992 and 2022, the adjusted mean LOLE decreased by 36% to 55%: from 4.4 to 2.0 years and from 3.3 to 1.9 years in 50-year-old women and men, respectively, and from 1.7 to 1.0 years and from 1.4 to 0.9 years in 80-year-old women and men, respectively. CONCLUSIONS: LOLE is higher in younger individuals, women, and those with reduced LVEF, but is attenuated when adjusting for comorbidities and risk factors. Advances in MI treatment during the past 30 years have almost halved LOLE, with no clear sign of leveling off to a plateau.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cohort studies, left, life expectancy, myocardial infarction, prognosis, risk factors, ventricular function
in
Circulation
volume
150
issue
11
pages
10 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:38966988
  • scopus:85197774527
ISSN
0009-7322
DOI
10.1161/CIRCULATIONAHA.124.068739
language
English
LU publication?
yes
id
7810effd-62c6-4650-8263-09a79a0552df
date added to LUP
2024-11-28 14:51:34
date last changed
2025-07-11 09:41:10
@article{7810effd-62c6-4650-8263-09a79a0552df,
  abstract     = {{<p>BACKGROUND: The effect of myocardial infarction (MI) on life expectancy is difficult to study because the prevalence of MI hinders direct comparison with the life expectancy of the general population. We sought to assess this in relation to age, sex, and left ventricular ejection fraction (LVEF) by comparing individuals with MI with matched comparators without previous MI. METHODS: We included patients with a first MI between 1991 and 2022 from the nationwide SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), each matched with up to 5 comparators on age, sex, and region of residence. Flexible parametric survival models were used to estimate excess mortality and mean loss of life expectancy (LOLE) depending on index year, age, sex, and LVEF, and adjusted for differences in characteristics. RESULTS: A total of 335 748 cases were matched to 1 625 396 comparators. A higher LOLE was observed in younger individuals, women, and those with reduced LVEF (&lt;50%). In 2022, the unadjusted and adjusted mean LOLE spanned from 11.1 and 9.5 years in 50-year-old women with reduced LVEF to 5 and 3.7 months in 80-year-old men with preserved LVEF. Between 1992 and 2022, the adjusted mean LOLE decreased by 36% to 55%: from 4.4 to 2.0 years and from 3.3 to 1.9 years in 50-year-old women and men, respectively, and from 1.7 to 1.0 years and from 1.4 to 0.9 years in 80-year-old women and men, respectively. CONCLUSIONS: LOLE is higher in younger individuals, women, and those with reduced LVEF, but is attenuated when adjusting for comorbidities and risk factors. Advances in MI treatment during the past 30 years have almost halved LOLE, with no clear sign of leveling off to a plateau.</p>}},
  author       = {{Reitan, Christian and Andell, Pontus and Alfredsson, Joakim and Erlinge, David and Hofmann, Robin and Lindahl, Bertil and Simonsson, Moa and Dickman, Paul W. and Jernberg, Tomas}},
  issn         = {{0009-7322}},
  keywords     = {{cohort studies; left; life expectancy; myocardial infarction; prognosis; risk factors; ventricular function}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{826--835}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Circulation}},
  title        = {{Excess Mortality and Loss of Life Expectancy After Myocardial Infarction : A Registry-Based Matched Cohort Study}},
  url          = {{http://dx.doi.org/10.1161/CIRCULATIONAHA.124.068739}},
  doi          = {{10.1161/CIRCULATIONAHA.124.068739}},
  volume       = {{150}},
  year         = {{2024}},
}