Clinical and Economic Outcomes Following First-Time Myocardial Infarction: A Nationwide Cohort Study from the SWEDEHEART Registry

Reitan, C ORCID: 0000-0002-6460-4853, Watanabe, AH, Bash, LD ORCID: 0000-0002-6036-2498, Galvain, T ORCID: 0000-0002-0412-249X, Arnet, U ORCID: 0009-0007-9592-620X and Jernberg, T ORCID: 0000-0003-1695-379X Clinical and Economic Outcomes Following First-Time Myocardial Infarction: A Nationwide Cohort Study from the SWEDEHEART Registry. European heart journal. Quality of care & clinical outcomes. ISSN 2058-5225 (Accepted)

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Abstract

Background and Aims
This study aimed to estimate consequences of myocardial infarction (MI) on long-term outcomes and resource needs by comparing outcomes, healthcare resource use, and associated costs between first-time MI patients and matched controls.

Methods
First-time MI patients from the nationwide SWEDEHEART registry, along with matched controls without prior MI (matched by sex, age, and region) 2012-2022, were included. Follow-up continued through November 2024 and assessed major adverse cardiovascular events (MACE), defined as cardiovascular death, MI, ischemic stroke, acute limb ischemia, or urgent arterial revascularization, as well as, healthcare resource use and associated costs.

Results
Among 118,810 first-time MI patients and 588,687 matched controls, followed for a median (IQR) of 6.6 (4.2-9.4) years, the 10-year MACE probability was 48.5% vs. 21.1% (HR [95% CI] 3.65 [3.61–3.69]), mainly due to higher rate of cardiovascular death (21.7% vs. 11.1%), MI (18.4% vs. 5.9%), and arterial revascularization (22.9% vs. 4.2%). Associations attenuated after adjustment for baseline characteristics but remained significant (MACE: adjHR[95%CI]: 3.18[3.15-3.22]). Cases had twice as many inpatient visits (0.65 vs. 0.32/patient year) and inpatient days (3.05 vs. 1.67/patient year), with nearly double the mean annual total costs (€7,266 vs. €3,934) when outpatient visits and medication also were included. Differences were greatest in the first year but persisted, especially among females and those with risk factors such as hypertension or diabetes.

Conclusions
First-time MI patients have persistently higher risks of cardiovascular death, MI, and ischemic stroke, along with greater healthcare use and costs, underscoring the need for effective prevention.

Item Type:	Article
Uncontrolled Keywords:	costs; health care resource utilization; matched controls; myocardial infarction; prognosis; 4203 Health Services and Systems; 32 Biomedical and Clinical Sciences; 42 Health Sciences; Prevention; Cerebrovascular; Women's Health; Clinical Research; Heart Disease; Heart Disease - Coronary Heart Disease; Cardiovascular; Brain Disorders; Stroke; Aging; Health Services; Cardiovascular; 3 Good Health and Well Being; 3201 Cardiovascular medicine and haematology; 4206 Public health
Subjects:	Q Science > QA Mathematics > QA75 Electronic computers. Computer science R Medicine > RC Internal medicine
Divisions:	Computer Science and Mathematics
Publisher:	Oxford University Press
Date of acceptance:	10 April 2026
Date of first compliant Open Access:	7 May 2026
Date Deposited:	07 May 2026 08:22
Last Modified:	07 May 2026 08:22
DOI or ID number:	10.1093/ehjqcco/qcag071
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28529

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