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35th AM (2025) - Poster Session
Care Provision, Morbidity, and Mortality Post-Acut ...
Care Provision, Morbidity, and Mortality Post-Acute Myocardial Infarction (AMI) in Individuals...
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Pdf Summary
This population-based retrospective cohort study analyzed acute myocardial infarction (AMI) outcomes among Ontario residents (N=185,834) hospitalized between 2013-2023, comparing individuals receiving opioid agonist therapy (OAT) within the prior year (n=832; proxy for extramedical opioid use) to those without OAT. Mortality among people who use extramedical opioids (PWUEO) is known to be tenfold higher than the general population, with cardiovascular disease a major driver. PWUEO have elevated cardiovascular risk due to behavioral factors (e.g., smoking, poor diet), infections, coexisting illnesses, and opioid effects, compounded by healthcare access and engagement barriers.<br /><br />Key findings showed that AMI patients with past-year OAT were younger, predominantly male, from lower-income neighborhoods, and less likely to have diabetes or hypertension. While overall revascularization rates were similar, those on OAT were significantly less likely to receive higher-risk procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Adjusted models revealed that OAT patients experienced 1.3 times longer hospital stays and had a 2.6-fold higher risk of mortality within one year post-AMI, indicating greater morbidity and potential disparities in quality or access to care. These results persisted after accounting for demographic and clinical factors.<br /><br />The study highlights the need for integrated, targeted AMI care pathways tailored to PWUEO to improve timely diagnosis, equitable access to advanced cardiovascular interventions, and post-discharge care to reduce preventable morbidity and mortality. Limitations include reliance on OAT as a proxy for opioid use, potentially missing undiagnosed or untreated cases, and limited adjustment for confounders such as smoking and polysubstance use due to data constraints. Future research will incorporate additional comorbidities and examine further outcomes including follow-up care, medication adherence, emergency visits, and readmissions.<br /><br />Overall, addressing systemic barriers and stigma in cardiovascular care for PWUEO is critical to reducing the observed disparities in survival and health outcomes after AMI.
Keywords
acute myocardial infarction
opioid agonist therapy
extramedical opioid use
cardiovascular disease
mortality risk
percutaneous coronary intervention
coronary artery bypass grafting
healthcare disparities
population-based cohort study
Ontario residents
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