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

## TL;DR

Older adults in the US who experience multiple heart attacks face higher risks of death and financial hardship compared to those with a single heart attack.

## Contribution

This study identifies the increased risks of death, nursing home placement, and impoverishment specifically associated with recurrent myocardial infarction in older adults.

## Key findings

- Recurrent MI was associated with a 2.04 times higher risk of death compared to initial MI.
- Recurrent MI was associated with a 1.32 times higher risk of impoverishment.
- After adjusting for factors, recurrent MI was linked to slightly lower nursing home placement risk.

## Abstract

To determine whether recurrent myocardial infarction (MI) is associated with increased risk of mortality, long-term nursing home placement, and impoverishment.

Retrospective cohort study.

United States Medicare program.

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).

Death, nursing home placement, and impoverishment (Medicaid enrollment or subsidies for low-income and -resource individuals) through December 31, 2017.

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.

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.

•Recurrent myocardial infarction may cause death and impoverishment.•Comorbidities and other characteristics explain higher risk of nursing home placement.•Secondary prevention may reduce the risk of impoverishment as well as death.

Recurrent myocardial infarction may cause death and impoverishment.

Comorbidities and other characteristics explain higher risk of nursing home placement.

Secondary prevention may reduce the risk of impoverishment as well as death.