Myocardial Infarction in the Population

DESCRIPTION (provided by applicant): Coronary heart disease (CHD) trends measured via our companion grant R01 HL 59205 document adverse secular trends among the elderly with regards to CHD mortality, MI incidence and post-MI survival. These trends, consistent across all indicators measured, document a shift in the burden of CHD towards older segments of the population and underscore the importance of including all ages to capture age-related differences in outcome and of the access to outpatient data to comprehensively characterize the burden of prevalent CHD. To provide insight into the impact and determinants of CHD trends, which have substantial implications in an aging population, a comprehensive analysis of post-MI outcomes including recurrent ischemic events and heart failure is needed. Indeed, although declining over time, heart failure remains frequent after incident MI and its determinants are not well known. In particular, there is virtually no population-based data on the occurrence of left ventricular (LV) dysfunction and LV remodeling (defined by changes over time in LV geometry), a known precursor of heart failure and on the independent role of age on LV remodeling. The acquisition of such data will be limited by the following factors: 1) Older age groups, comprising the highest risk and fastest growing segment of the population, are not included in several surveillance programs. 2) Recent changes in the bio-marker used to diagnose MI clinically will introduce discontinuity in the trends measured through passive surveillance and modify the spectrum of disease labeled as MI. 3) Hospital-based surveillance does not capture outpatient outcomes, an important component of disease prevalence with current shifts away from in-patient care. The exceptional patient-oriented research environment at the Mayo Clinic optimized by the Mayo Clinic Echocardiographic Laboratory and the Rochester Epidemiology Project is a unique resource to address these questions thereby providing a rich experience in patient oriented research to junior investigators. Thus, building on methods implemented through our companion grant, in conjunction with novel and prospective approaches, the objective of this K24 grant is to develop a program to mentor junior investigators in patient-oriented research. The scientific aims of this application are to examine: 1) Using prospectively acquired data, the impact of the implementation of Troponin-based diagnostic algorithms on the incidence of hospitalized MI and on CHD mortality. 2) The trends in the severity, natural history and utilization of cardiac procedures after incident MI and the impact of age on such trends. 3) Using prospectively acquired data, the prevalence and change in echocardiographically determined parameters of LV geometry and function in order to determine the prevalence of LV systolic dysfunction after MI, and the incidence of post-MI LV remodeling. To optimize the training potential of these series of studies and the learning experience of mentees a strong mentoring plan is outlined in details in this revised application.