National Trends and Recurrence of Hospitalized Acute Myocardial Infarction in Indonesia, 2019–2024: A Population-Based Claims Analysis

Gita Yolanda; Arditya Damarkusuma

doi:10.30701/ijc.2131

Gita Yolanda Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0009-0008-2256-4698
Arditya Damarkusuma Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Department of Cardiology and Vascular Medicine, Dr. Sardjito General Hospital/Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

Keywords: Acute myocardial infarction, Recurrent AMI, AMI Incidence, Universal Health Coverage, Indonesia

Abstract

Background: Acute Myocardial Infarction (AMI) and recurrent AMI remain major contributors to cardiovascular morbidity and mortality in Indonesia. However, national data describing trends in hospitalized AMI incidence and recurrent AMI, particularly during the Coronavirus Disease 2019 (COVID-19) pandemic, are limited.

Methods: We conducted a population-based analysis using nationally representative Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan, Social Health Insurance Administration Body) claims sample data from 2019 to 2024, excluding 2021 due to incomplete data. Hospitalized AMI incidence and temporal trends were evaluated using a repeated cross-sectional design, whereas recurrent AMI was examined using longitudinal patient-level linkage. AMI episodes were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes (I21–I22). Survey-weighted analyses estimated the incidence of hospitalized AMI, and survey-weighted logistic regression examined factors associated with recurrent AMI.

Results: We identified 9,494 AMI episodes among 7,618 unique patients. Hospitalized AMI incidence per 100,000 insured population declined from 58.1 in 2019 to 49.8 in 2020, followed by a sustained increase, reaching 80.5 in 2024 and exceeding pre-pandemic levels. Overall, 13.5% of patients experienced recurrent AMI. Recurrent AMI was independently associated with heart failure (OR 3.72; 95% CI 2.84–4.88), hypertension (OR 3.00; 95% CI 2.27–3.96), diabetes mellitus (OR 1.61; 95% CI 1.19–2.17), and male sex (OR 1.57; 95% CI 1.20–2.05). Older age (≥65 years) was not independently associated with recurrent AMI.

Conclusions: Hospitalized AMI incidence in Indonesia rebounded from the early COVID-19 decline and reached its highest level observed in 2024. Recurrent AMI clustered around modifiable cardiometabolic conditions, highlighting critical gaps in secondary prevention. Within a universal health coverage system, recurrent AMI may be a measurable, potentially preventable population-level outcome.

Downloads

Download data is not yet available.

Author Biography

Gita Yolanda, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

References

1. World Health Organization. Cardiovascular diseases (CVDs) [Internet]. 2025 [cited 2025 Dec 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
2. Muharram FR, Multazam CECZ, Mustofa A, Socha W, Andrianto, Martini S, et al. The 30 years of shifting in the Indonesian cardiovascular burden: analysis of the Global Burden of Disease study. J Epidemiol Glob Health. 2024 Mar 1;14(1):193–212.
3. Holzmann MJ, Andersson T, Doemland ML, Roux S. Recurrent myocardial infarction and emergency department visits: a retrospective study on the Stockholm area chest pain cohort. Open Heart. 2023 Jun 29;10(1):e002200.
4. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014 Aug 28;371(9):818–27.
5. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007 Jun 7;356(23):2388–98.
6. Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, et al. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the PURE study. Lancet Glob Health. 2019 Jun 1;7(6):e748–60.
7. Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007 Jan 17;297(3):286–94.
8. Arsyad DS, Hageman SH, Qalby N, Ansariadi, Wahiduddin, Qanitha A, et al. Very high risk of recurrent cardiovascular events in Indonesian patients with established coronary heart disease. J Asian Pac Soc Cardiol. 2023 Aug 31;2:100041.
9. Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung SH, et al. The COVID-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med. 2020 Aug 13;383(7):691–3.
10. De Rosa S, Spaccarotella C, Basso C, Calabrò MP, Curcio A, Filardi PP, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J. 2020 Jun 7;41(22):2083–8.
11. Gramegna M, Baldetti L, Beneduce A, Pannone L, Falasconi G, Calvo F, et al. ST-segment–elevation myocardial infarction during COVID-19 pandemic. Circ Cardiovasc Interv. 2020 Aug 1;13(8):e009413.
12. Dale CE, Takhar R, Carragher R, Katsoulis M, Torabi F, Duffield S, et al. The impact of the COVID-19 pandemic on cardiovascular disease prevention and management. Nat Med. 2023 Jan;29(1):219–25.
13. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022 Mar;28(3):583–90.
14. Dharma S, Andriantoro H, Purnawan I, Dakota I, Basalamah F, Hartono B, et al. Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta acute coronary syndrome registry. BMJ Open. 2016 Aug 31;6:e012193.
15. Alkatiri AH, Qanitha A, Muzakkir AF, Kaharuddin AT, Nashar AH, Qalby N, et al. Six-month clinical outcomes after ST-elevation myocardial infarction in eastern Indonesia: a prospective cohort study. Sci Rep. 2025 Dec;15(1):10211.
16. Harmadha WSP, Muharram FR, Gaspar RS, Azimuth Z, Sulistya HA, Firmansyah F, et al. Explaining the increase of incidence and mortality from cardiovascular disease in Indonesia: a global burden of disease study analysis (2000–2019). PLoS One. 2023 Dec;18(12):e0295497.
17. BPJS Kesehatan. Laporan Pengelolaan Program Tahun 2024 dan Laporan Keuangan Tahun 2024 (Auditan) [Internet]. Jakarta; 2025 [cited 2025 Dec 25]. Available from: https://webbpjs.azurewebsites.net/uploads/information/04072025044926-144f0ee1-1967-468d-b2fe-b65cb5250a4d.pdf
18. BPJS Kesehatan. Laporan Pengelolaan Program Tahun 2020 dan Laporan Keuangan Tahun 2020 (Auditan) [Internet]. Jakarta; 2021 [cited 2025 Dec 1]. Available from: https://webbpjs.azurewebsites.net/uploads/information/b1ccf38a84e322f2cf5f648b857f1de0.pdf
19. BPJS Kesehatan. Laporan Pengelolaan Program Tahun 2022 dan Laporan Keuangan Tahun 2022 (Auditan) [Internet]. Jakarta; 2023 [cited 2025 Dec 1]. Available from: https://webbpjs.azurewebsites.net/uploads/information/05072024032036-d0e43b7b-4628-4963-8cb4-a2104605a2e6.pdf
20. BPJS Kesehatan. Laporan Pengelolaan Program Tahun 2023 dan Laporan Keuangan Tahun 2023 (Auditan) [Internet]. Jakarta; 2024 [cited 2025 Dec 1]. Available from: https://webbpjs.azurewebsites.net/uploads/information/05072024032036-d0e43b7b-4628-4963-8cb4-a2104605a2e6.pdf
21. BPJS Kesehatan. Buku data sampel BPJS Kesehatan 2015–2020. Jakarta; 2021.
22. World Health Organization. International statistical classification of diseases and related health problems, 10th revision (ICD-10). 10th ed. Geneva: World Health Organization; 2019.
23. Ando T, Ooba N, Mochizuki M, Koide D, Kimura K, Lee SL, et al. Positive predictive value of ICD-10 codes for acute myocardial infarction in Japan: a validation study at a single center. BMC Health Serv Res. 2018 Nov 26;18(1):895.
24. Rymer JA, Chen AY, Thomas L, Fonarow GC, Peterson ED, Wang TY. Readmissions after acute myocardial infarction: how often do patients return to the discharging hospital? J Am Heart Assoc. 2019 Oct 1;8(19):e012766.
25. Kim LK, Yeo I, Cheung JW, Swaminathan RV, Wong SC, Charitakis K, et al. Thirty-day readmission rates, timing, causes, and costs after ST-segment–elevation myocardial infarction in the United States: a national readmission database analysis 2010–2014. J Am Heart Assoc. 2018 Sep 1;7(18):e009863.
26. Republic of Indonesia. Undang-Undang Nomor 13 Tahun 2011 tentang Penanganan Fakir Miskin. Indonesia; 2011.
27. Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9(1):1–19.
28. Reynolds K, Go AS, Leong TK, Boudreau DM, Cassidy-Bushrow AE, Fortmann SP, et al. Trends in incidence of hospitalized acute myocardial infarction in the Cardiovascular Research Network (CVRN). Am J Med. 2017 Mar;130(3):317–27.
29. Li S, Peng Y, Wang X, Qian Y, Xiang P, Wade SW, et al. Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population. Clin Cardiol. 2019 Mar;42(3):391–9.
30. Southern DA, Roberts B, Edwards A, Dean SNP, Svenson LW, Larsen E, et al. Validity of administrative data claim-based methods for identifying individuals with diabetes at a population level. Can J Public Health. 2010 Feb;101(1):61–4.