Over the last decade, speeding up treatment for patients who experience a heart attack in outpatient settings has improved significantly, but those efforts have ignored improving treatment for inpatients who experience a heart attack, according to a study in JAMA — and inpatients who have a heart attack are more likely to die than those who have one in an outpatient setting.
Researchers performed an analysis of ST-elevation myocardial infarctions occurring between 2008 and 2011 in California. They classified the STEMI as inpatient onset or outpatient onset based on admission codes, and patients who had a STEMI and were hospitalized for acute coronary syndromes were excluded from the analysis. A total of 62,021 STEMIs were identified, and 3,068 occurred in hospitalized, non-ACS patients.
Through the analysis, they found patients who had a heart attack in the hospital had more than three-fold greater in-hospital mortality than patients who had the heart attack outside of the hospital (33.6 percent compared to 9.2 percent). Additionally, inpatient-onset STEMI patients were less likely to be discharged to home (33.7 percent vs. 69.4 percent) and less likely to undergo cardiac catheterization or percutaneous coronary intervention.
"The question of how to improve outcomes and define optimum treatment in hospitalized patients who experience a STEMI is an area that merits more attention and concern," the study authors wrote. "Although there have been improvements in treatment times and clinical outcomes in patients who have onset of STEMI, few initiatives have focused on optimizing care of hospitalized patients with onset of STEMI after admission."