Low-quality care after STEMI in cancer patients increased risk of death with HR 7.0 at 30 days, HR 4.0 at 1 year, and HR 2.6 at 5 years versus optimal care.
Does optimum quality of care improve short- and long-term survival in adults with STEMI and cancer?
Receiving low quality of care during STEMI admission is associated with a significantly higher risk of short- and long-term mortality in patients with concurrent cancer.
Abstract Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge. Methods A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project (MINAP) and UK national Hospital Episode Statistics Admitted Patient Care (HES APC) registries. We used the composite opportunity-based quality indicator (OBQI) to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves. Results In total, 6,787 STEMI indexed admissions with cancer were identified. Of those, 4,340 (63.9%) patients received optimum care, 1,320 (19.5%) intermediate care, and 1,127(25.2%) low care quality. Patients with low care quality were older (optimum quality median (IQR)=72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)) and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days (HR 7.0, 95% CI 5.7-8.7), 1 year (HR 4.0, 95% CI 3.6-4.4), and 5 years (HR 2.6, 95% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67-102), 508 (95% CI 468-548), and 1096 (95% CI 1034-1158) at 30 days, one year, and five years respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions. Conclusion Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.
Dafaalla et al. (2025) studied this question. Low-quality care after STEMI in cancer patients increased risk of death with HR 7.0 at 30 days, HR 4.0 at 1 year, and HR 2.6 at 5 years versus optimal care.