Clinical and economic burden of patients with and without myocardial infarction: a contemporary nationwide 10-year registry comparison

Abstract Background Although previous studies have described the clinical and economic implications of atherosclerotic cardiovascular disease (ASCVD), contemporary comparisons of disease burden, healthcare resource utilization (HCRU), and costs between patients with and without a history of myocardial infarction (MI) remain limited. This study aimed to describe the long-term clinical outcomes, HCRU, and costs in a representative sample of patients with MI and compare them with those without a prior MI. Methods All patients with an index event of first time MI (n=118,810) registered in the nationwide Swedish SWEDEHEART registry and matched controls without previous MI (n=588,687) from the Swedish Population Registry matched on sex, age, and geographical area were included between January 2012 to January 2022. All individuals were followed until September 2024. The rate of major adverse cardiovascular events (MACE) was assessed through crude cumulate rates at 1-, 5-, and 10-year follow-up periods and adjusted Cox regression modeling. HCRU and costs, estimated using DRG weights as well as national price lists using in- and outpatient register data, were assessed using linear regression modeling and adjusted based on baseline characteristics. Results The median age of the study population was 71 years (IQR: 62–79), and 35% were female (Table 1). The population was observed for a median of 6.5 years. Among MI cases, most had non-ST-elevation MI (61%), 73% underwent percutaneous coronary intervention, and 5.5% underwent coronary bypass surgery at their initial event. Compared to controls, patients with MI had a higher prevalence of comorbidities. After one year, one in four (25.6%) of the MI cases had experienced a MACE plus compared to 2.4% in the control group (Table 2). After 10 years, nearly half of the MI patients (48.0%) had experienced a MACE plus, compared to 20.6% of controls (adjusted HR 95% CI: 3.26 3.22–2.29). During follow-up, MI patients had a fourfold higher mean number of hospitalizations (2.15 vs. 0.51) and spent three times more days in the hospital on average (9.71 vs. 3.05) per year. The mean total cost was 4.6 times higher in MI cases compared to controls (€20,450 vs. €4,423 per year). Conclusion There is a significantly increased risk of all measured component and composite cardiovascular events and higher healthcare resource utilization and costs among patients with a history of MI compared to controls without MI, even when adjusting for differences in baseline characteristics. A better understanding of the clinical and economic burden associated with ASCVD in the real-world setting is needed for the development and implementation of tailored approaches to reduce the burden of cardiovascular disease and improve patient outcomes.