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Missing even one key part of MI care worsens patients' outcome

Patients admitted to hospital with MI are more likely to die after discharge if they miss out on any of nine key recommended treatments, a UK study has found.

The team used data from the MINAP (Myocardial Ischaemia National Audit Project) – a national registry – to study the quality of care and outcomes of patients with ST-segment elevation MI (STEMI) who were discharged from hospital in England and Wales between January 2007 and December 2010.

Just over 50,000 of these patients were eligible to receive all nine components of the recommended STEMI care pathway, namely:  pre-hospital electrocardiogram, acute use of aspirin, timely coronary reperfusion, prescription of aspirin on discharge from hospital, timely use of ACE inhibitors, beta-blockers, ARBs and statins; and referral for cardiac rehabilitation after discharge from hospital.

However, of 31,000 eligible patients who had complete data, over half (51%) missed at least one of these opportunities of care.

Patients had a 74% increased chance of dying within one year of discharge if they missed just one component of the pathway, and a 46% increased risk of dying within a month of discharge if they did not receive one of these opportunities of care.

The researchers also found a dose-response relationship, with patients 22% more likely to die after 30 days with each additional treatment missed, up to four or more missed opportunities of care.

Lead researcher Dr Chris Gale, from the school of medicine at the University of Leeds, said: ‘Many of these guideline recommended steps are straightforward, but for some reason they are not being provided. If more components of care are missed, the chance of dying increases further.’

Professor Peter Weissberg, medical director at the British Heart Foundation, said: ‘The key message is that someone’s recovery from a heart attack is not solely dependent on any single element of the care pathway. This research shows the importance of ensuring all elements of care for heart attack patients are optimally delivered.’

European Heart Journal Acute Cardiovascular Care 2014; Available online 15 September  

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Readers' comments (2)

  • Ivan Benett

    These finding are not surprising, or indeed at odds with our local audit in Central Manchester. Post MI-patients are very infrequently on full medication and even fewer are discharged on optimal therapy. Thereafter, the responsibility for care seems to slip between GP and hospital. The only post-MI item of care that is completed to any significant level is the assessment of LV function. Cardiac rehabilition in particular has low referral rates and poor uptake and completion, and yet has up, to 25% mortality benefit. I shall be publishing a paper in the of Primary Care Cardiology Journalthat outlines what I consider to be the role of the GP in managing people post-MI. It is based on the recent publication of the Post-MI NICE guideline. I hope readers find it helpful

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  • MI care and folllow up of this is TOTALLY the responsibility of the cardiologist who needs to ensure all this happens. It is NOT the responsibility of the GP to check what secondry care is doing....we can only police so much and our learned "colleagues" need to be doing what the evidence shows, not us. Sorry my two pennies worth. There is only so much responsibility a GP can take. Next it will be post CVA, cancer etc guidelines, the specialists need to take this on, not do a half assed job and turf back to GP to pick up the pieces.

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