Acute MI patients sent to noncardiac units face higher risk of death

Location, location, location. Patients with acute MI who mistakenly were admitted to noncardiology departments were more likely to die before and after discharge than counterparts treated in coronary care units, according to a subanalysis of the DEF-AMI study. Their mortality risk was almost twice as high.

DEF-AMI (Consequences of the universal Definition of Acute Myocardial Infarction studied prospectively in a Danish consecutive hospital population) enrolled more than 7,000 patients who presented at the Odense University Hospital in Denmark between 2010 and 2011 and had cardiac troponin I measured. DEF-AMI researchers used a subset of participants to evaluate the clinical characteristics and long-term mortality of patients with acute MI.

Of the 3,762 patients in the subanalysis, 479 had an acute MI; 24 percent were sent to noncardiology departments and 76 percent to a coronary care unit. Compared with patients admitted to the cardiac units, patients admitted to noncardiology departments were older, had more comorbidities and were more often women. A larger proportion of patients treated in noncardiology departments presented with dyspnea and a smaller proportion received guideline-indicated treatment within three months of discharge.

The mortality rate was higher for patients admitted to noncardiac departments compared with coronary care units. At a median follow-up of 2.1 years, it was 64 percent vs. 21 percent. In-hospital, 30-day and one-year rates were 20 percent vs. 7 percent; 27 percent vs. 8 percent; and 53 percent vs. 14 percent, respectively.

Deaths attributed to cardiovascular causes were more frequent in patients admitted to noncardiac units. All in all, the hazard ratio for acute MI patients in the noncardiac vs. cardiac departments was 2.

The DEF-AMI team acknowledged that treatment at their hospital, which is a tertiary care university hospital, may not be representative of care in other settings. But their findings shed light on patient characteristics and outcomes for those with acute MI who accidently are admitted into noncardiology units and show there is opportunity for better cooperation between the two hospital settings.

“Based on our data, it appears that the group of patients admitted to NCDs [noncardiology departments] with an AMI [acute MI] is rather complex and characterized by a large burden of risk factors, mixed infarction types, and a high frequency of extra-cardiac morbidities, suggesting the need for a broad-spectrum of treatments in addition to the specific cardiac care,” they wrote.

The results were published in the Oct. 15 issue of the American Journal of Cardiology.