Objective: The objective of this dissertation was to examine cardiovascular (CV) outcomes in patients admitted for acute myocardial infarction (AMI) within United States (U.S.) community hospitals, focusing on three areas: impact of primary payer type among patients admitted for ST-segment elevation myocardial infarction (STEMI); effect of weekday vs. weekend admissions among STEMI hospitalizations; examination of trends in AMI type over a 10-year timeframe. Results: Chapter 1 results indicated

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... that among patients <65, those with private insurance as the primary payer type were significantly less likely to experience in-hospital mortality vs. patients with other primary forms of payment. In Chapter 2, results suggested that odds of in-hospital mortality in the overall cohort for weekday vs. weekend admissions depended on patient's race in 2005 and 2008, with no significant difference observed in 2010; however those with comorbid diabetes had more favorable outcomes when admitted on a weekday across all years studied. In Chapter 3, we observed an approximately 54% decrease in STEMI, and 10% decrease in NSTEMI hospitalizations over the timeframe studied; however the odds of in-hospital mortality remained significantly higher for STEMI vs. NSTEMI admissions over the decade. Conclusions: Results of this research suggest the following: 1) Patients <65 who have private health insurance experience lower odds of in-hospital mortality vs. those with other primary forms of payment; 2) In recent years, admission day does not appear to impact in-hospital mortality, except in those with comorbid diabetes; and 3) The clinical presentation of AMI within U.S. community hospitals has changed over the past decade; however STEMI admissions are still associated with increased odds of in-hospital mortality vs. NSTEMI admissions. iv ACKNOWLEDGEMENTS I would like to express my sincere thanks to my committee members, Drs. George