Heart attack at hospital may up death risk

Patients who experience a certain type of heart attack during hospitalisation face greater risk of death than outpatients, researchers, including one of Indian-origin, have found.
Prashant Kaul, of the University of North Carolina, Chapel Hill, and colleagues focused on the heart condition ST-elevation myocardial infarction.
They found that patients developing inpatient-onset STEMI had more than three-fold greater in-hospital mortality than those with outpatient-onset STEMI (33.6 per cent vs 9.2 per cent).
STEMI is a certain pattern on an electrocardiogram following a heart attack.
The study included an analysis of STEMIs occurring between 2008 and 2011 as identified in the California State Inpatient Database.

Models were used to evaluate associations among location of onset of STEMI, resource utilisation and outcomes.

Patients with inpatient-onset STEMI were also less likely to be discharged home (33.7 per cent vs 69.4 per cent), and were less likely to undergo cardiac catheterisation (33.8 per cent vs 77.8 per cent) or PCI (21.6 per cent vs 65 per cent).
Average length of stay (13 days vs 5 days) and inpatient charges (USD 245,000 vs USD 129,000) were higher for inpatient-onset STEMI.
"The question of how to improve outcomes and define optimum treatment in hospitalised patients who experience a STEMI is an area that merits more attention," researchers said.

"Although there have been improvements in treatment times and clinical outcomes in outpatients who have onset of STEMI, few initiatives have focused on optimising care of hospitalised patients with onset of STEMI after admission," they said.
The study appears in the journal JAMA.