AMI patients not enrolled in quality registries were older, less treated invasively, and had higher in-hospital mortality (21% vs 5.8%) and mortality risk (HR 1.19).
Does non-enrollment in a quality registry correlate with differences in clinical management and outcomes in patients with acute myocardial infarction?
AMI patients not enrolled in quality registries are older, frailer, receive fewer guideline-directed therapies, and have significantly worse short- and long-term outcomes, highlighting important selection biases in registry data.
Absolute Event Rate: 0% vs 0%
Abstract Purpose To investigate differences in baseline characteristics and clinical management in patients enrolled in a national registry for acute myocardial infarction (AMI) with patients not enrolled, and to study the association between enrolment and long-term outcome. Methods : We identified all hospitalizations due to a first or a recurrent AMI between 2006 2021 in a region of Sweden (N=48,522) by using data from the SCREAM project. After excluding rehospitalizations due to AMI within 30 days, 47,342 hospitalizations (40,964 unique patients) remained. Patients were considered as enrolled to quality registry if any entry was found in the SWEDEHEART registry during the period of hospitalization. Results Non-enrolled patients (N=6,113) were significantly older (median age 84 years, IQR: 76-89), more frail (Hospital Frailty Risk Score HFRS, 7 points, IQR: 3-13 vs 5 points, IQR: 1-10, P 0.001) and hade a worse kidney function at admission (mean estimated glomerular filtrate rate 55±24 mL/min/1.73m² vs 71±24 mL/min/1.73m², P 0.001) compared to enrolled patients. Non-enrolled patients were less often provided coronary angiography (19% vs 75%, P 0.001) and percutaneous coronary interventions (9.7% vs 58%, P 0.001). After adjusting for confounding factors, non-enrolled patients were significantly less likely to initiate/continue secondary preventive treatments, including acetylsalicylic acid (hazard ratio HR 0.87, 95% confidence interval CI 0.83–0.91), beta blockers (HR 0.86, CI 0.83–0.90), renin-angiotensin-aldosterone system inhibitors (HR 0.71, CI 0.68–0.75), and statins (HR 0.63, CI 0.60–0.67). Furthermore, non-enrolled patients had a higher in-hospital mortality rate (21% vs. 5.8%, P 0.001). After adjustment, non-enrollment was associated with poorer long-term outcomes, including an elevated risk of death (HR 1.19, CI 1.14–1.25) and reinfarction or stroke (HR 1.15, CI 1.06–1.23). Conclusions Patients with AMI who are not enrolled in quality registers are older, more frail, and have poorer kidney function. They are less likely to receive guideline-recommended invasive procedures and secondary preventive treatments. Non-enrollment is strongly associated with higher in-hospital mortality and worse long-term outcomes also after adjusting for multiple potential confounders.
Khedri et al. (Sat,) reported a other. AMI patients not enrolled in quality registries were older, less treated invasively, and had higher in-hospital mortality (21% vs 5.8%) and mortality risk (HR 1.19).