Association of inpatient vs outpatient onset of ST-elevation myocardial infarction with treatment and clinical
Prashant Kaul1, Jerome J Federspiel2, Xuming Dai1
1Division of Cardiology, University of North Carolina, Chapel Hill.
JAMA
|November 17, 2014
Summary
Patients experiencing ST-elevation myocardial infarction (STEMI) during hospitalization for other conditions faced higher mortality and less intervention. This highlights a critical gap in care for inpatient-onset STEMI compared to outpatient cases.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Significant improvements in reperfusion times for outpatient ST-elevation myocardial infarction (STEMI) exist.
- Quality improvement efforts have overlooked STEMI cases occurring in hospitalized patients (inpatient-onset STEMI).
Purpose of the Study:
- To determine the incidence of inpatient-onset STEMI in patients hospitalized for non-acute coronary syndromes (ACS).
- To identify variables associated with treatment and outcomes for these patients.
Main Methods:
- Retrospective analysis of STEMI cases from the California State Inpatient Database (2008-2011).
- STEMIs classified as inpatient-onset or outpatient-onset based on admission codes.
- Regression models used to assess associations with outcomes, adjusted for patient and hospital factors.
Main Results:
- 4.9% of STEMIs were inpatient-onset (n=3068) and occurred in older, more female patients.
- Inpatient-onset STEMI patients had higher in-hospital mortality (33.6% vs 9.2%) and lower rates of cardiac catheterization and PCI.
- Longer length of stay and higher inpatient charges were observed for inpatient-onset STEMI.
Conclusions:
- Patients with inpatient-onset STEMI received less invasive treatment and had worse outcomes than outpatient-onset STEMI patients.
- This study underscores disparities in care for hospitalized patients experiencing STEMI.
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