Key result
Non-cardiology ward admission for MI is linked to ~62% higher 5-year mortality.
Why the study?
The characteristics, treatment, and prognosis of patients with myocardial infarction treated outside a cardiology department compared with those treated at a cardiology department were not well defined.
Does treatment of myocardial infarction exclusively outside a cardiology department increase all-cause mortality and reduce utilization of invasive and secondary preventive therapies compared to treatment in a cardiology department?
Cohort (n=1,310)
Yes
Does treatment of myocardial infarction exclusively outside a cardiology department increase all-cause mortality and reduce utilization of invasive and secondary preventive therapies compared to treatment in a cardiology department?
Patients with myocardial infarction managed exclusively outside cardiology departments receive substantially less invasive evaluation and secondary preventive therapy and experience significantly higher short- and long-term mortality, even after adjusting for age and comorbidities.
Answers are grounded in this paper and cite their sources.
May warrant cardiology involvement for MI care; leaves open whether department assignment causally affects mortality in observational data.
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.
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Gard et al. (2020) conducted a cohort in Myocardial infarction (MI) (n=1,310). Treatment exclusively outside a cardiology department (non-CD) vs. Treatment at a cardiology department (CD, including coronary care and intermediate cardiac care units) at some point during the care event was evaluated on 5-year all-cause mortality (adjusted for baseline parameters) (HR 1.62, 95% CI 1.32-1.98). MI treatment exclusively outside cardiology departments was associated with higher adjusted all-cause mortality at 30 days, 1 year, and 5 years.
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