Journal article 877 views
Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
European Heart Journal: Acute Cardiovascular Care, Volume: 4, Issue: 3, Pages: 241 - 253
Swansea University Author:
Clive Weston
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DOI (Published version): 10.1177/2048872614548602
Abstract
In a cohort study of 112,286 patients with ST-elevation myocardial infarction (STEMI) surviving to hospital discharge between Jan 2007 and Dec 2010 A score was calculated for each patient based on the following components of care: pre-hospital ECG, acute use of aspirin, timely reperfusion, prescript...
| Published in: | European Heart Journal: Acute Cardiovascular Care |
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| ISSN: | 2048-8726 2048-8734 |
| Published: |
2015
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa18487 |
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| Abstract: |
In a cohort study of 112,286 patients with ST-elevation myocardial infarction (STEMI) surviving to hospital discharge between Jan 2007 and Dec 2010 A score was calculated for each patient based on the following components of care: pre-hospital ECG, acute use of aspirin, timely reperfusion, prescription at hospital discharge of aspirin, thienopyridine inhibitor, ACE-inhibitor (or equivalent), HMG-CoA reductase inhibitor and β-blocker, and referral for cardiac rehabilitation. In this way cumulative missed opportunities for care (CMOC) could be defined for each patient. Mixed-effects logistic regression models evaluated the effect of CMOC on risk-adjusted 30-day and 1-year mortality (RAMR).44.5% of patients were ineligible for one or more care component. Of patients eligible for all nine components, 50.6% missed one or more opportunity. Pre-hospital ECG and timely reperfusion were most frequently missed, predicting further missed care at discharge (pre-hospital ECG incident rate ratio [95% CI]: 1.64 [1.58–1.70]; timely reperfusion 9.94 [9.51–10.40]). Patients ineligible for care had higher RAMR than those eligible for care (30-days: 1.7% vs. 1.1%; 1-year: 8.6% vs. 5.2%), whilst those with no missed care had lower mortality than patients with ≥4 CMOC (30-days: 0.5% vs. 5.4%, adjusted OR (aOR) per CMOC group 1.22, 95% CI: 1.05–1.42; 1-year: 3.2% vs. 22.8%, aOR 1.23, 1.13–1.34).Opportunities for care in STEMI are commonly missed and significantly associated with early and later mortality. |
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| College: |
Faculty of Medicine, Health and Life Sciences |
| Issue: |
3 |
| Start Page: |
241 |
| End Page: |
253 |