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Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in the Nottingham heart attack register
1Division of Cardiovascular Medicine, University Hospital, Queen's Medical Centre, Nottingham.
Insights
Despite advances in acute myocardial infarction (AMI) treatments like beta blockers and aspirin, inpatient mortality rates remained unchanged over a decade. This study highlights a gap between improved management strategies and patient outcomes for heart attacks.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality worldwide.
- Understanding trends in AMI management and outcomes is crucial for improving patient care.
- Previous studies have indicated improvements in treatments for AMI.
Purpose of the Study:
- To evaluate changes in the incidence, treatment, and inpatient mortality of acute myocardial infarction over a 10-year period.
- To identify trends in patient demographics and hospital admission patterns for AMI.
- To assess the impact of evolving treatment protocols on mortality rates.
Main Methods:
- A retrospective analysis of the Nottingham heart attack register was conducted.
- Data from two district general hospitals covering urban and rural populations were analyzed.
- Patient records from 1982-4 and 1989-92 (excluding 1991) with confirmed AMI were included.
Main Results:
- Admissions for AMI increased, with a rise in the mean patient age and a decrease in hospital stay duration.
- There was a significant increase in the proportion of elderly patients (≥75 years) admitted to coronary care units.
- While use of beta blockers, aspirin, and thrombolytics increased, and timely admissions improved, inpatient mortality rates showed no significant change.
- 15% of patients were still admitted after the recommended time window for thrombolysis.
Conclusions:
- Despite increased utilization of evidence-based treatments for acute myocardial infarction, inpatient mortality rates did not improve between 1982 and 1992.
- The findings suggest that while treatment protocols have advanced, they have not yet translated into reduced mortality for AMI patients.
- Further research is needed to understand the factors contributing to the lack of mortality improvement.
Objective:
To assess longitudinal trends in admissions, management, and inpatient mortality from acute myocardial infarction over 10 years.
Design:
Retrospective analysis based on the Nottingham heart attack register.
Setting:
Two district general hospitals serving a defined urban and rural population.
Subjects:
All patients admitted with a confirmed acute myocardial infarction during 1982-4 and 1989-92 (excluding 1991, when data were not collected).
Main Outcome Measures:
Numbers of patients, background characteristics, time from onset of symptoms to admission, ward of admission, treatment, and inpatient mortality.
Results:
Admissions with acute myocardial infarction increased from 719 cases in 1982 to 960 in 1992. The mean age increased from 62.1 years to 66.6 years (P < 0.001), the duration of stay fell from 8.7 days to 7.2 days (P < 0.001), and the proportion of patients aged 75 years and over admitted to a coronary care unit increased significantly from 29.1% to 61.2%. A higher proportion of patients were admitted to hospital within 6 hours of onset of their symptoms in 1989-92 than in 1982-4, but 15% were still admitted after the time window for thrombolysis. Use of beta blockers increased threefold between 1982 and 1992, aspirin was used in over 70% of patients after 1989, and thrombolytic use increased 1.3-fold between 1989 and 1992. Age and sex adjusted odds ratios for inpatient mortality remained unchanged over the study period.
Conclusions:
Despite an increasing uptake of the "proved" treatments, inpatient mortality from myocardial infarction did not change between 1982 and 1992.