Missed Care Increases Death Risk After Heart Attack

Opportunities for care are often missed in heart attack patients, leading to increased mortality rates, the results of a recent study suggest.

The study, published online September 15, 2014, in the European Heart Journal: Acute Cardiovascular Care, analyzed data from patients discharged from a hospital between 2007 and 2010 after experiencing ST-elevation myocardial infarction. The researchers of the study identified whether patients received, after their heart attack, 9 critical components of care, which included an electrocardiogram (ECG); the immediate use of aspirin; timely reperfusion; prescriptions at discharge for aspirin, a thienopyridine inhibitor, an ACE inhibitor, an HMG-CoA reductase inhibitor, and a beta-blocker; and a referral for cardiac rehabilitation.

Among patients who could safely receive all 9 components, 50.6% missed 1 or more of the treatment steps. Prehospital ECG and timely reperfusion were the most frequently missed components and were associated with further missed care opportunities at discharge. In addition, patients who missed 4 or more treatment steps had a 5.4% risk of death 1 month after discharge, compared with a 0.5% 1-month risk among those who received all 9 steps. After 1 year, that risk increased to 22.8% among patients who did not receive all care components, compared with just 3.2% among those who received all components.