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Inpatient STEMI outcomes worse than outpatient onset
Patients hospitalized for other conditions while developing STEMI showed worse outcomes and greater use of resources than those who were admitted for the onset of STEMI, according to research from the University of North Carolina, Chapel Hill.
Patients were identified between 2008 and 2011 through the California State Inpatient Database using ICD-9 codes. Of the 12 million hospitalizations in the database, 62,021 patients with STEMI were identified, 3,068 (4%) of whom developed STEMI after hospitalization for another condition.
Patients who developed STEMI after admission were more likely to be female (47.4% vs. 32%), older (mean age, 71.5 years vs. 64.9 years) and have more comorbidities.
After adjustment for age, sex, comorbidities and hospital characteristics, patients with inpatient-onset STEMI were less likely than patients with outpatient-onset STEMI to undergo cardiac catheterization (33.8% vs. 77.8%) or PCI (21.6% vs. 65%).
Greater usage of resources was shown in patients with inpatient-onset STEMI by longer length of stay (13.4 days vs. 4.7 days) and inpatient charges ($245,000 vs. $129,000).
Adjusted inpatient mortality was more than three times as high for inpatient-onset STEMI (OR=3.05; 95% CI, 2.76-3.38), and patients were less likely to be discharged to their homes after inpatient-onset STEMI (OR=0.38; 95% CI, 0.34-0.42).
“The difference in mortality in the current study between those with inpatient-onset STEMI and outpatient-onset STEMI is at least partially related to those already hospitalized being older, having more comorbid conditions, and having a concurrent illness or recent surgery,” the researchers wrote. “This study demonstrates that mortality associated with inpatient-onset STEMI was progressively higher in patients deemed at higher risk (based on a model developed from patients in the California database who did not experience an inpatient-onset STEMI).”
Disclosure: The researcher reported no relevant financial disclosures.