Anton Gard1,2, Bertil Lindahl1,2, Nermin Hadziosmanovic1,2, Tomasz Baron1,2. 1. Department of Medical Sciences, Cardiology, Uppsala University, 751 85 Uppsala, Sweden. 2. Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden.
Abstract
AIM: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. METHODS: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. RESULTS: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62-3.22), one year (HR 1.82; 95% CI 1.39-2.36) and five years (HR 1.62; 95% CI 1.32-1.98). CONCLUSIONS: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.
AIM: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. METHODS: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. RESULTS: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CDpatients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CDpatients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CDpatients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62-3.22), one year (HR 1.82; 95% CI 1.39-2.36) and five years (HR 1.62; 95% CI 1.32-1.98). CONCLUSIONS: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.
Authors: Dorien M Kimenai; Bertil Lindahl; Andrew R Chapman; Tomasz Baron; Anton Gard; Ryan Wereski; Steven J R Meex; Tomas Jernberg; Nicholas L Mills; Kai M Eggers Journal: Heart Date: 2021-04-20 Impact factor: 7.365