{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:34:14Z","timestamp":1773725654363,"version":"3.50.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,1,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Acute myocardial infarction (AMI) with in\u2010hospital onset (AMI\u2010IHO) has poor prognosis but is clinically underappreciated. Whether its occurrence has changed over time is uncertain.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Since 1987, the ARIC (Atherosclerosis Risk in Communities) study has conducted adjudicated surveillance of AMI hospitalizations in 4 US communities. Our analysis was limited to patients aged 35 to 74 years with symptomatic AMI. Patients with symptoms initiating after hospital arrival were considered AMI\u2010IHO. A total of 26\u00a0678 weighted hospitalizations (14\u00a0276 unweighted hospitalizations) for symptomatic AMI were identified from 1995 to 2014, with 1137 (4%) classified as in\u2010hospital onset. The population incidence rate of AMI\u2010IHO increased in the 4 ARIC communities from 1995 through 2004 to 2005 through 2014 (12.7\u201416.9 events per 100\u00a0000 people;\n              <jats:italic>P<\/jats:italic>\n              for 20\u2010year trend &lt;0.0001), as did the proportion of AMI hospitalizations with in\u2010hospital onset (3.7%\u20136.1%;\n              <jats:italic>P<\/jats:italic>\n              for 20\u2010year trend =0.03). The 10\u2010year proportions were stable for patients aged 35 to 64 years (3.0%\u20133.4%;\n              <jats:italic>P<\/jats:italic>\n              for 20\u2010year trend =0.3) but increased for patients aged \u226565\u00a0years (4.6%\u20137.8%;\n              <jats:italic>P<\/jats:italic>\n              for 20\u2010year trend =0.008;\n              <jats:italic>P<\/jats:italic>\n              for interaction by age group =0.04). AMI\u2010IHO had a more severe clinical course with lower use of AMI therapies or invasive strategies and higher in\u2010hospital (7% versus 3%), 28\u2010day (19% versus 5%), and 1\u2010year (29% versus 12%) mortality (\n              <jats:italic>P&lt;<\/jats:italic>\n              0.0001 for all).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In this population\u2010based community surveillance, AMI\u2010IHO increased from 2005 to 2014, particularly among older patients. Quality initiatives to improve recognition and management of AMI\u2010IHO should be especially focused on hospitalized patients aged &gt;65.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018414","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T13:25:27Z","timestamp":1609853127000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Trends, Management, and Outcomes of Acute Myocardial Infarction Hospitalizations With In\u2010Hospital\u2010Onset Versus Out\u2010of\u2010Hospital Onset: The ARIC Study"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-5147","authenticated-orcid":false,"given":"Melissa C.","family":"Caughey","sequence":"first","affiliation":[{"name":"Joint Department of Biomedical Engineering University of North Carolina and North Carolina State University NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6387-3015","authenticated-orcid":false,"given":"Sameer","family":"Arora","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of North Carolina School of Medicine NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arman","family":"Qamar","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology &amp; Vascular Medicine NorthShore University Health System, University of Chicago Pritzker School of Medicine Evanston IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7288-7435","authenticated-orcid":false,"given":"Zainali","family":"Chunawala","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohit D.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Cardiology Gobind Ballabh Pant Institute of Postgraduate Medical Education New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puneet","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Cardiology Janakpuri Super Specialty Hospital New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0885-1953","authenticated-orcid":false,"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9651-3836","authenticated-orcid":false,"given":"Ambarish","family":"Pandey","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Texas Southwestern Dallas TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuming","family":"Dai","sequence":"additional","affiliation":[{"name":"Division of Cardiology Lang Research CenterNew York Presbyterian Queens Hospital Flushing NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Sidney C.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of North Carolina School of Medicine NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7179-718X","authenticated-orcid":false,"given":"Kunihiro","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.13.1410"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15236"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.3031"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008661"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.047480"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2015.165"},{"key":"e_1_3_2_8_2","first-page":"1028","article-title":"The effects of Medicare on health care utilization and outcomes","volume":"5","author":"Lichtenberg FR","year":"2006","unstructured":"Lichtenberg FR. 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