Key result
Non-cardiology IHO-AMI management is linked to ~2.77x higher in-hospital mortality and fewer guideline therapies.
Why the study?
Patients with in-hospital onset acute myocardial infarction (IHO-AMI) are less likely to receive guideline-directed therapies, and differences in in-hospital management are influenced by admitting departments.
Does management in non-cardiology departments compared to cardiology departments affect guideline-directed therapy use and mortality in patients with in-hospital onset acute myocardial infarction?
Does management in non-cardiology departments compared to cardiology departments affect guideline-directed therapy use and mortality in patients with in-hospital onset acute myocardial infarction?
Patients developing acute myocardial infarction while hospitalized in non-cardiology departments receive significantly less guideline-directed therapy and have higher short- and long-term mortality compared to those in cardiology departments.
Highlights potential care gaps for IHO-AMI outside cardiology; extends observational evidence on departmental disparities without establishing causality.
Background The in-hospital management of acute myocardial infarction (AMI) significantly affects patient survival. Compared to patients with out-of-hospital onset AMI, the percentage of in-hospital onset AMI (IHO-AMI) patients receiving guideline-directed therapies is significantly lower. Differences in in-hospital management are influenced by the departments. Purpose To evaluate the differences in in-hospital management and mortality between cardiology and non-cardiology departments for patients with IHO-AMI. Methods This retrospective cohort study identified patients with IHO-AMI from the Tianjin Health and Medical Data Platform from January 1, 2013 to December 31, 2022. We compared the mortality and in-hospital management of patients with IHO-AMI between cardiology and non-cardiology departments. Logistic regression was used to analyze in-hospital management and in-hospital mortality differences between departments, and Cox regression models and landmark analysis assessed the impact of department on long-term mortality (30-day and 1-year). Propensity score matching (PSM) was utilized for sensitivity analysis. Results During the study period, a total of 15,259 patients with IHO-AMI were included. IHO-AMI patients occurred in non-cardiology departments differed in their baseline characteristics compared to those occurred in cardiology department: they were older, more often female, and had more non-cardiovascular diseases (diabetes mellitus, stroke, chronic kidney disease, anemia, and pneumonia). Compared with IHO-AMI occured in cardiology, these occurred in non-cardiology were less likely to receive guideline-directed therapies (aspirin [75.7% versus 47.1%], P2Y12 inhibitors [84.4% versus 56.3%], beta-blockers [62.7% versus 43.2%], ACEI/ARB [53.6% versus 32.6%], statins [84.6% versus 57.4%], anticoagulant therapy [78.5% versus 56.4%], reperfusion therapy [27.5% versus 7.2%]). IHO-AMI patients occurred in non-cardiology departments had significantly higher rates of in-hospital, 30-day and 30-day to1-year mortality compared to those in cardiology (odds ratio (OR)=2.77, 95% CI: 2.31 to 3.32; hazard ratio (HR)=2.23, 95% CI: 1.95 to 2.55; HR=1.79, 95% CI: 1.54 to 2.07). Sensitivity analysis further confirmed these findings. Conclusions The in-hospital management of IHO-AMI patients is closely related to the department in which they are occurred. Patients with IHO-AMI in non-cardiology departments were less likely to receive guideline directed therapies and face a higher risk of death. Thus, it is crucial to enhance the recognition and treatment strategies for IHO-AMI patients in non-cardiology departments, aiming to reduce in-hospital and long-term mortality. Admission department with mortality Graphical Abstract
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Zhang et al. (2025) studied this question. IHO-AMI patients in non-cardiology departments received fewer guideline therapies (e.g., aspirin 47.1% vs 75.7%) and had 2.77x higher in-hospital mortality than those in cardiology.
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