A missed opportunity? Many type 2 MI patients are never evaluated by a cardiologist
A significant number of patients who have a type 2 myocardial infarction (MI) are not being evaluated by a cardiologist, according to new research published in Circulation: Cardiovascular Quality and Outcomes.
“Notably, patients with type 2 MI have high rates of recurrent events and may deserve tailored management,” wrote lead author Cian P. McCarthy, MB, BCh, BAO, of Massachusetts General Hospital in Boston, and colleagues. “How often patients are evaluated by a cardiologist during hospitalization and the association between these evaluations and diagnostic testing and treatments is uncertain.”
To learn more about this topic, the authors tracked data from 359 patients with a type 2 MI who were treated at a single facility. Patients received care from October 2017 to May 2018, and a team of physicians review the chart of each individual included in the study.
Overall, just 57.7% of patients with a type 2 MI were actually evaluated by a cardiologist. Patients who did and did not undergo a cardiologist-led evaluation presented with similar rates of chest pain, shortness of breath, ST-segment changes and ischemic T wave abnormalities.
However, patients who saw a cardiologist were much more likely to undergo stress testing (13.5% vs. 3.3%), transthoracic echocardiography (80.2% vs. 50.7%) and coronary angiography (21.3% vs. 0%) during their initial admission.
All-cause mortality rates were similar between the two groups—11.6% for patients who saw a cardiologist and 9.2% for those who did not.
In addition, the team observed, patients were more likely to be discharged on a statin, clopidogrel or a beta blocker if they met with a cardiologist. Prescriptions for aspirin, prasugrel, ticagrelor, angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers were the same between the two groups.
Another key finding was that 53% of patients who saw a cardiologist had an outpatient cardiology follow-up appointment. Just 19.2% of patients who did not see a cardiologist initially had such an appointment.
“Our analysis raises the possibility of gaps in care for patients with type 2 MI,” the authors wrote. “Cardiologist evaluation is associated with mortality reduction for MI generally and outpatient follow-up is associated with increased adherence to secondary preventative therapies after MI. However, in this analysis, fewer than two-thirds of patients with type 2 MI were evaluated by a cardiologist during their admission and most type 2 MI patients did not have outpatient cardiology follow-up after their event.”
The team did note that its study had certain limitations, such as the fact that it was a retrospective study. McCarthy et al. called for additional research in this area.
Read the full Circulation: Cardiovascular Quality and Outcomes study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.