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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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