Patients with in-hospital onset STEMI face worse outcomes

According to a study published Nov. 19 in JAMA, patients whose STEMI occurred in hospital had poorer outcomes than those whose STEMI occurred beyond the hospital doors. These findings from Prashant Kaul, MD, of the division of cardiology at the University of North Carolina in Chapel Hill, and colleagues confirmed findings from earlier studies indicating that patients who were already in the hospital at the time of their STEMI had fewer invasive tests and procedures and higher mortality rates.

Reviewing patient data from a California state database of patient information, Kaul et al found that 62,021 incidents of STEMI were logged between 2008 and 2012 in 303 hospitals across the state. Of that, 4.9 percent occurred to patients who were already hospitalized for non-acute coronary syndromes.

Patients with in-hospital STEMI had a little more than three times higher odds of dying post-STEMI. These patients also were significantly less likely to receive PCI than out-of-hospital STEMI counterparts; rates of intervention were 21.6 vs. 65 percent, respectively. Cardiac catheterization occurred in 77.8 percent of out-of-hospital STEMI cases, while only being performed in 33.8 percent of in-hospital STEMI cases.

In-hospital STEMI also had a burden of longer mean stay lengths (13.4 days vs. 4.7 days) and higher mean in-patient costs ($245,000 vs. $129,000).

Kaul et al found that patients for whom STEMI onset occurred in hospital were older and more often female. These patients also had a greater burden of comorbidities, including renal failure, peripheral vascular disease, congestive heart failure and chronic lung disease. Surgical procedures played a role in 49.6 percent of inpatient-onset STEMI cases.

“Although there have been improvements in treatment times and clinical outcomes in outpatients who have onset of STEMI, few initiatives have focused on optimizing care of hospitalized patients with onset of STEMI after admission,” they wrote. Kaul et al noted updated process measures need to be put into place to better assist patients already in the hospital at the time of STEMI onset to improve outcomes.