Heart Disease and Stroke Statistics—2010 Update: Chapter 4 more women than men died in the hospital: 9.3% of women died in the hospital compared with 6.2% of men.42
Operations and Procedures ●
In 2006, an estimated 1 313 000 inpatient PCI procedures, 448 000 inpatient bypass procedures, 1 115 000 inpatient diagnostic cardiac catheterizations, 114 000 inpatient implantable defibrillators, and 418 000 pacemaker procedures were performed for inpatients in the United States.43
Cost ● ●
The estimated direct and indirect cost of CHD for 2010 is $177.1 billion. In 2006, $11.7 billion was paid to Medicare beneficiaries for in-hospital costs when CHD was the principal diagnosis ($14 009 per discharge for AMI, $12 977 per discharge for coronary atherosclerosis, and $10 630 per discharge for other ischemic HD).35,44
The percentage of ACS or MI cases with ST elevation varies in different registries/databases and depends heavily on the age of patients included and the type of surveillance used. According to the National Registry of Myocardial Infarction 4 (NRMI-4), ⬇29% of MI patients are STEMI patients.45 The AHA Get With the Guidelines project found that 32% of the MI patients in the CAD module are STEMI patients (personal communication from AHA Get With the Guidelines staff, October 1, 2007). The study of the Global Registry of Acute Coronary Events (GRACE), which includes US patient populations, found that 38% of ACS patients have STEMI, whereas the second Euro Heart Survey on ACS (EHS-ACSII) reported that ⬇47% of ACS patients have STEMI.46 ●
Acute Coronary Syndrome ICD-9 codes 410, 411. The term acute coronary syndrome (ACS) is increasingly used to describe patients who present with either AMI or UA. (UA is chest pain or discomfort that is accelerating in frequency or severity and may occur while at rest but does not result in myocardial necrosis.) The discomfort may be more severe and prolonged than typical AP or may be the first time a person has AP. UA, non–ST-segment– elevation MI (NSTEMI), and ST-segment– elevation MI (STEMI) share common pathophysiological origins related to coronary plaque progression, instability, or rupture with or without luminal thrombosis and vasospasm. ●
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A conservative estimate for the number of discharges with ACS from hospitals in 2006 is 733 000. Of these, an estimated 401 000 are male and 332 000 are female. This estimate is derived by adding the first-listed inpatient hospital discharges for MI (647 000) to those for UA (86 000; NHDS, NCHS). When secondary discharge diagnoses in 2006 were included, the corresponding number of inpatient hospital discharges was 1 365 000 unique hospitalizations for ACS; 765 000 were male, and 600 000 were female. Of the total, 810 000 were for MI alone, and 537 000 were for UA alone (18 000 hospitalizations received both diagnoses; NHDS, NCHS).
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Analysis of data from the GRACE multinational observational cohort study of patients with ACS found evidence of a change in practice for both pharmacological and interventional treatments in patients with either STEMI or non–ST-segment– elevation ACS (NSTE ACS). These changes have been accompanied by significant decreases in the rates of in-hospital death, cardiogenic shock, and new MI among patients with NSTE ACS. The use of evidencebased therapies and PCI interventions increased in the STEMI population. This increase was matched with a statistically significant decrease in the rates of death, cardiogenic shock, and HF or pulmonary edema.47 A study of patients with NSTE ACS treated at 350 US hospitals found that up to 25% of opportunities to provide American College of Cardiology (ACC)/AHA guideline– recommended care were missed in current practice. The composite guideline adherence rate was significantly associated with in-hospital mortality.48 A study of hospital process performance in 350 centers of nearly 65 000 patients enrolled in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) National Quality Improvement Initiative found that ACC/AHA guideline–recommended treatments were adhered to in 74% of eligible instances.48
Angina Pectoris ICD-9 413; ICD-10 I20. See Table 4-2; and Chart 4-5.
Prevalence ●
A study of 4 national cross-sectional health examination studies found that among Americans 40 to 74 years of age, the age-adjusted prevalence of AP was higher among women than men. Increases in the prevalence of AP occurred for Mexican American men and women and African American women but were not statistically significant for the latter.49
Decisions about medical and interventional treatments are based on specific findings noted when a patient presents with ACS. Such patients are classified clinically into 1 of 3 categories, according to the presence or absence of STsegment elevation on the presenting ECG and abnormal (“positive”) elevations of myocardial biomarkers such as troponins as follows:
Incidence
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STEMI NSTEMI UA
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Only 18% of coronary attacks are preceded by longstanding AP (NHLBI computation of FHS follow-up since 1986).
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