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Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study

A. Simms, C. Weston, R. West, A. Hall, P. Batin, A. Timmis, H. Hemingway, K. Fox, C. Gale, Clive Weston Orcid Logo

European Heart Journal: Acute Cardiovascular Care, Volume: 4, Issue: 3, Pages: 241 - 253

Swansea University Author: Clive Weston Orcid Logo

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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...

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Published in: European Heart Journal: Acute Cardiovascular Care
ISSN: 2048-8726 2048-8734
Published: 2015
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URI: https://cronfa.swan.ac.uk/Record/cronfa18487
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first_indexed 2014-09-18T01:55:28Z
last_indexed 2018-07-24T18:41:19Z
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2018-07-24T16:18:23.0451939</datestamp><bib-version>v2</bib-version><id>18487</id><entry>2014-09-17</entry><title>Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study</title><swanseaauthors><author><sid>df85e4e0e139d0f46eb683174eba98a9</sid><ORCID>0000-0002-8995-8199</ORCID><firstname>Clive</firstname><surname>Weston</surname><name>Clive Weston</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2014-09-17</date><deptcode>PMSC</deptcode><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 &#x3B2;-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&#x2013;1.70]; timely reperfusion 9.94 [9.51&#x2013;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 &#x2265;4 CMOC (30-days: 0.5% vs. 5.4%, adjusted OR (aOR) per CMOC group 1.22, 95% CI: 1.05&#x2013;1.42; 1-year: 3.2% vs. 22.8%, aOR 1.23, 1.13&#x2013;1.34).Opportunities for care in STEMI are commonly missed and significantly associated with early and later mortality.</abstract><type>Journal Article</type><journal>European Heart Journal: Acute Cardiovascular Care</journal><volume>4</volume><journalNumber>3</journalNumber><paginationStart>241</paginationStart><paginationEnd>253</paginationEnd><publisher/><issnPrint>2048-8726</issnPrint><issnElectronic>2048-8734</issnElectronic><keywords/><publishedDay>16</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2015</publishedYear><publishedDate>2015-09-16</publishedDate><doi>10.1177/2048872614548602</doi><url/><notes></notes><college>COLLEGE NANME</college><department>Medicine</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PMSC</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2018-07-24T16:18:23.0451939</lastEdited><Created>2014-09-17T20:42:50.2410760</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>A.</firstname><surname>Simms</surname><order>1</order></author><author><firstname>C.</firstname><surname>Weston</surname><order>2</order></author><author><firstname>R.</firstname><surname>West</surname><order>3</order></author><author><firstname>A.</firstname><surname>Hall</surname><order>4</order></author><author><firstname>P.</firstname><surname>Batin</surname><order>5</order></author><author><firstname>A.</firstname><surname>Timmis</surname><order>6</order></author><author><firstname>H.</firstname><surname>Hemingway</surname><order>7</order></author><author><firstname>K.</firstname><surname>Fox</surname><order>8</order></author><author><firstname>C.</firstname><surname>Gale</surname><order>9</order></author><author><firstname>Clive</firstname><surname>Weston</surname><orcid>0000-0002-8995-8199</orcid><order>10</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2018-07-24T16:18:23.0451939 v2 18487 2014-09-17 Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study df85e4e0e139d0f46eb683174eba98a9 0000-0002-8995-8199 Clive Weston Clive Weston true false 2014-09-17 PMSC 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. Journal Article European Heart Journal: Acute Cardiovascular Care 4 3 241 253 2048-8726 2048-8734 16 9 2015 2015-09-16 10.1177/2048872614548602 COLLEGE NANME Medicine COLLEGE CODE PMSC Swansea University 2018-07-24T16:18:23.0451939 2014-09-17T20:42:50.2410760 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine A. Simms 1 C. Weston 2 R. West 3 A. Hall 4 P. Batin 5 A. Timmis 6 H. Hemingway 7 K. Fox 8 C. Gale 9 Clive Weston 0000-0002-8995-8199 10
title Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
spellingShingle Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
Clive Weston
title_short Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
title_full Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
title_fullStr Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
title_full_unstemmed Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
title_sort Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study
author_id_str_mv df85e4e0e139d0f46eb683174eba98a9
author_id_fullname_str_mv df85e4e0e139d0f46eb683174eba98a9_***_Clive Weston
author Clive Weston
author2 A. Simms
C. Weston
R. West
A. Hall
P. Batin
A. Timmis
H. Hemingway
K. Fox
C. Gale
Clive Weston
format Journal article
container_title European Heart Journal: Acute Cardiovascular Care
container_volume 4
container_issue 3
container_start_page 241
publishDate 2015
institution Swansea University
issn 2048-8726
2048-8734
doi_str_mv 10.1177/2048872614548602
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description 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.
published_date 2015-09-16T03:21:41Z
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score 11.012678

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