Higher death rate for heart attack patients with additional non-cardiac conditions

Heart attack patients who also have another acute condition such as stroke, kidney failure and pneumonia may have a poorer outcome than those without these conditions, and those with the most severe conditions account for a disproportionate percentage of hospital deaths, researchers at Yale School of Medicine report in a recent American Journal of Medicine.

About one third of patients with a heart attack (acute myocardial infarction) also have an active, noncardiac condition that could warrant admission to the hospital, according to first author Judith Lichtman , assistant professor in the Division of Chronic Disease Epidemiology in the Department of Epidemiology and Public Health at Yale School of Medicine.

"Relatively little is known about the care and outcomes of heart attack patients who arrive at the hospital with an additional active non-cardiac condition," said Lichtman. "We were interested in describing the frequency and severity of acute non-cardiac conditions that could be present at the time of hospital admission for a heart attack. We were also interested in understanding how these other conditions influence the care and outcomes of complex patients, since their doctors were faced with managing more than one potentially life-threatening condition at the time of admission."

Lichtman and colleagues studied 1,145 acute myocardial infarction (AMI) patients discharged from Yale-New Haven between January 1997 and June 2000, who were enrolled in the national Registry of Myocardial Infarction (NRMI) database. The team rated the additional non-cardiac conditions in these patients by severity--from acute, life-threatening conditions posing an imminent risk of death to significant though not life-threatening noncardiac conditions that would warrant admission.

Of these patients, 8.5 percent had an acute, life-threatening, non-cardiac condition when they were admitted and 19.5 percent had another significant non-cardiac condition. Life-threatening conditions included active bleeding, pneumonia requiring intubation, major stroke, metastatic cancer, acute renal failure requiring dialysis, abdominal aortic aneurysm rupture, acute psychosis and major trauma.

"Our findings reveal that patients who present with the most severe conditions at admission have a disproportionately high hospital mortality risk," said Lichtman. "More research is needed to describe these complex patients to identify opportunities to improve their clinical management."

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Other authors on the study included Amir Fathi, M.D., Martha J. Radford, M.D., Zhenqiu Lin and Caroline S. Loeser, M.D. and senior author Harlan M. Krumholz, M.D.

Citation: American Journal of Medicine, Vol. 119 N0. 10 (October 2006)


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