A medical costs study of older patients with acute myocardial infarction and metabolic syndrome in hospital

Abstract

Background

Older patients with acute myocardial infarction (AMI) usually have a poor prognosis, but whether this poor prognosis leads to high hospital costs remains unclear. This study investigated the clinical outcomes of and costs incurred by older patients with AMI and metabolic syndrome (MS) in hospital.

Methods and results

Patients with AMI seen at Qilu Hospital of Shandong University between January 2011 and May 2013 were separated into four groups: young non-MS patients (n=282), older non-MS patients (n=324), young MS patients (n=217), and older MS patients (n=174). We found that advanced age was significantly associated with worse clinical outcomes, and that the clinical outcomes in patients with AMI and MS are also worsened. At the same cost (RMB¥10,000), older patients with and without MS had a markedly increased number of cardiovascular incidences compared with younger patients without MS. In a comparison of the incremental cost-effectiveness ratio (ICER) of percutaneous coronary intervention, older patients without MS had a lower ICER for cardiovascular incidences and a higher ICER for cardiac event-free survival rate when compared with young patients without MS, but a lower ICER for cardiovascular incidences and a higher ICER for cardiac event-free survival rate when compared with older MS patients.

Conclusion

Older AMI patients have poor clinical outcomes and their treatment is not cost-effective; however, the results are worse in patients with AMI and MS. Percutaneous coronary intervention is a cost-effective therapy in older patients with AMI, but its cost-effectiveness decreases in patients with AMI and MS.

Keywords:

• metabolic syndrome
• aging
• vascular
• acute myocardial infarction
• cost-effectiveness

Acknowledgments

This work was supported by research grants from the National Basic Research Program of China (973 Program, 2013CB530700), the National Natural Science Foundation of China (81070192, 81070141, 81100605, 81270352, and 81270287), the Natural Science Foundation of Shandong Province (BS2013YY017), the Independent Innovation Foundation of Shandong University (2012JC034), and the Cardiovascular Exploration Research Foundation of the Chinese Medical Doctor Association (DFCMDA201320).

Disclosure

The authors report no competing interests in this work.

Supplementary material

Table S1 Logistic regression analysis of individual predictors of acute heart failure, atrial arrhythmia, ventricular arrhythmia, and death in elderly AMI patients