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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3031 — Acute Myocardial Infarction Among the Inpatients in VA Hospitals

Author List:
Kopjar B (VA Puget Sound Health Care System)
Sales A (VA Puget Sound Health Care System)
Au D (VA Puget Sound Health Care System)
Young B (VA Puget Sound Health Care System)
Sun H (VA Puget Sound Health Care System)
Wagner T (VA Puget Sound Health Care System)
Rusch R (VA Puget Sound Health Care System)

Objectives:
To determine the characteristics, treatments and outcomes of veterans who sustained acute myocardial infarction (AMI) during a non-AMI hospitalization.

Methods:
The study is based on the national cohort of patients having AMI during a VA hospitalization between August 15, 2003, and May 15, 2004. Data was obtained by chart abstraction performed for the Department of Veterans Affairs (VA) Office of Quality and Performance. Patients who had sustained an inpatient AMI during an admission for a non-AMI diagnosis were selected and further divided into surgical and non-surgical patients.

Results:
We identified 6,938 patients who sustained an AMI. 1,056 (15%) sustained an AMI (4 per 1,000 hospitalized patients) while hospitalized for other reasons: 326 (31%) among surgical patients (5.1 per 1,000 surgical cases), and 730 (69%) among non-surgical patients (3.6 per 1,000 non-surgical cases). Among the surgical AMI cohort, the most frequent procedures performed included gastrointestinal, orthopedic, and vascular. Among the non-surgical patients, the most common diagnoses were diseases of heart and blood vessels, respiratory diseases and gastrointestinal diseases. Overall in-patient mortality was 23 per 100 cases (20.6 per 100 surgical cases and 24.4 per 100 non-surgical cases), significantly greater than patients admitted for AMI (7.6 per 100 cases). Thirty-day post-MI mortality was 22 per 100 cases (18.4 per 100 surgical cases and 23.4 per 100 non-surgical cases), which was also significantly greater than the 30-day mortality for patients initially admitted for AMI (8.7 per 100 cases). At discharge, the majority of patients received guideline recommended AMI care (aspirin (81.4%), beta-blockers (93.4%), ACE-inhibitors (80.8%).

Implications:
In comparison to non-hospitalized patients who sustain a myocardial infarction and survive to hospital presentation, inpatient and 30-day mortality was significantly worse among patients who had myocardial infarction as inpatients having been admitted for other reasons. This higher mortality rate may be in part due to selection bias and confounding by comorbidity.

Impacts:
AMI that occurs during hospitalization is understudied and has unique clinical features, complex treatment requirements, and poorer outcomes.


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