Analysis of the hospitalization time impact on hospital mortality from acute myocardial infarction

Keywords: acute myocardial infarction, risk factors, time of hospitalization, hospital mortality

Abstract

Diseases of the circulatory system and their most severe form – acute myocardial infarction (AMI) – is one of the most important problems of modern medicine due to the steady increase in morbidity, negative impact on quality of life, early disability of patients. 19.5 % of patients die from AMI, 50 % among which die 90-120 minutes after the first symptoms of the disease.

The aim of the research was to analyse the impact of hospitalization on the mortality of patients with AMI and predict the risk of death in case of untimely hospitalization of this category of patients.

Materials and methods. We have conducted a retrospective analysis of 876 medical records of patients diagnosed with AMI who were treated in the cardiology department of Kharkiv Regional Clinical Hospital in 2019. During the study, we have used retrospective, logical, medical and statistical methods. Odds ratios and a 95 % confidence interval were also calculated.

Results and discussion. The research revealed the impact of hospitalization on the organization of medical care and hospital mortality of patients with AMI. It was found that the largest share of patients with AMI, both among the dead and those who left the hospital, were hospitalized in the period from 2 to 12 hours from the onset of the disease (49.6 % and 52.33 %, respectively), as well as in period after 24 hours – 28.00 % and 21.70 %, respectively. The largest share of patients with AMI, regardless of the time of hospitalization were persons older than 60 years. The results of the analysis showed that in the period up to 2 h from the onset of the disease, the share of hospitalized patients with more severe heart muscle damage (presence of Q wave) was 91.35 % against 8.65 % of patients with AMI without ST segment elevation. It should be noted that in almost 50 % of cases, patients with AMI without ST segment elevation were hospitalized after 24 h from the onset of the disease. At the same time, the largest share of deaths in this group of patients was observed in the hospital stay from 12 to 24 hours. According to the results of the research, risk factors for fatal outcome in AMI were identified, in particular male gender, the presence of an established ECG diagnosis of NSTEMI, conducting SKA in patients with AMI. It was also found that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %.

Conclusions. The obtained data indicate a strong relationship between the time of hospitalization and the organization of medical care and hospital mortality of patients with AMI. It is reliably established that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %: HS is 0.483 (95 % CI 0.238 – 0.981), p=0.175.

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Author Biographies

Bogdan Fedak, Kharkiv Medical Academy of Postgraduate Education

Department of Organization of health care, public administration

Inna Lobova, Kharkiv Medical Academy of Postgraduate Education

Department of Organization of health care, public administration

References

Terenda, N.O. (2015). Death rate from cardio-vascular diseases as a state problem. Bulletin of Scientific Research, 4, 11–13.

Hruzevа, T. S., Haliienko, L. I., Dufinets, V. A. (2016). Medical and social aspects of the problem of non-infectious diseases as reflected by the world, European and national statistics. East European Journal of Public Health, 1 (26), 15–22.

Anosova, E. V., Prashchayeu, K. I. (2011). The role of the ultrasound methods for the estimation of the biological age of human beings in the deteriorating environmental situation and the steady growth of morbidity and mortality from cardiovascular disease. Scien. J., 7, 238–242.

Terenda, N. O. (2015) Prognostic estimation of incidence and prevalence of diseases of circulatory system. Bulletin of Social Hygiene and Health Protection Organization of Ukraine, 3 (65), 35–40. doi: http://doi.org/10.11603/1681-2786.2015.3.5763

Tseluyko, V. I., Yarova, O. D. (2017). Long-term observation results of patients with atherosclerosis of the peripheral arteries of the lower extremities. Heart & Vessels, 4, 39–47.

Kuznetsov, V. A., Yaroslavskaya, E. I., Pushkarev, G. S., Zyryanov, I. P., Bessonov, I. S., Gorbatenko, E. A., Nyamtsu, A. M. (2014). Interrelation of transcutaneous coronary interventions for acute forms of coronary heart disease and mortality parameters in tyumen region inhabitants. Russian Journal of Cardiology, 6, 42–46. doi: http://doi.org/10.15829/1560-4071-2014-6-42-46

Terenda, N. O. (2017). Impact of time of hospitalization of myocardial infarction patients on effectiveness of medical care. Bulletin of Scientific Research, 2, 60–63. doi: http://doi.org/10.11603/2415-8798.2017.2.7850

Foo, C. Y., Bonsu, K. O., Nallamothu, B. K., Reid, C. M., Dhippayom, T., Reidpath, D. D., Chaiyakunapruk, N. (2018). Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis. Heart, 104 (16), 1362–1369. doi: http://doi.org/10.1136/heartjnl-2017-312517

Steg, Ph. G., James, S. K, Atar, D., Badano, L. P., Lundqvist, C. B., Borger, M. A. et. al. (2012). Task Force on the management of ST-segment elevation acute myocardial infarction of the Europe an Society of Cardiology (ESC). ESC Guidelines for the management of acutemyocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 33, 2569–2619. doi: http://doi.org/10.1093/eurheartj/ehs215

Skybchyk, V. A. (2017). Modern approaches in management of patients with acute heart failure. Medicine of Ukraine, 3 (209), 13–19. doi: http://doi.org/10.37987/1997-9894.2017.3(209).222004

Kravchenko, V. V., Khotina, S. H., Sokolov, M. Yu., Talaieva, T. V., Lishchyshyna, O. M., Amosova, K. M. et. al. (2016). Guidelines for the emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care and medical rehabilitation "Acute coronary syndrome without ST segment elevation". Emergency medicine, 1 (72), 11–23.

Song, P.-S., Jeong, M. H. (2019). Incidence, Predictors, and Implications of Re-Hospitalization for Heart Failure after Acute Myocardial Infarction. Journal of Cardiac Failure, 25 (8), S151. doi: http://doi.org/10.1016/j.cardfail.2019.07.435

Lischyshyna, O. M., Stepanenko, A. V., Gorokh, Ye. L. (2010). Steps to development indicators of quality of medical care. Ukraine. Nation's Health, 4 (16), 85–91.

Verulava, T., Maglakelidze, T., Jorbenadze, R. (2017). Hospitalization Timeliness of Patients with Myocardial Infarction. Eastern Journal Of Medicine, 22 (3), 103–109. doi: http://doi.org/10.5505/ejm.2017.36854

Khalid, U., Jneid, H., Denktas, A. E. (2017). The relationship between total ischemic time and mortality in patients with STEMI: every second counts. Cardiovascular Diagnosis and Therapy, 7 (S2), S119–S124. doi: http://doi.org/10.21037/cdt.2017.05.10

Chandrasekhar, J., Marley, P., Allada, C., McGill, D., O’Connor, S., Rahman, M. et. al. (2017). Symptom-to-Balloon Time is a Strong Predictor of Adverse Events Following Primary Percutaneous Coronary Intervention: Results From the Australian Capital Territory PCI Registry. Heart, Lung and Circulation, 26 (1), 41–48. doi: http://doi.org/10.1016/j.hlc.2016.05.114

Kim, H. K., Jeong, M. H., Ahn, Y., Chae, S. C., Kim, Y. J., Hur, S. H. et. al. (2017). Relationship between time to treatment and mortality among patients undergoing primary percutaneous coronary intervention according to Korea Acute Myocardial Infarction Registry. Journal of Cardiology, 69 (1), 377–382. doi: http://doi.org/10.1016/j.jjcc.2016.09.002

Kawecki, D., Morawiec, B., Gąsior, M., Wilczek, K., Nowalany-Kozielska, E., Gierlotka, M. (2019). Annual Trends in Total Ischemic Time and One-Year Fatalities: The Paradox of STEMI Network Performance Assessment. Journal of Clinical Medicine, 8 (1), 78. doi: http://doi.org/10.3390/jcm8010078

Solhpour, A., Chang, K.-W., Arain, S. A., Balan, P., Loghin, C., McCarthy, J. J. et. al. (2015). Ischemic time is a better predictor than door-to-balloon time for mortality and infarct size in ST-elevation myocardial infarction: Ischemic Time Is Better Than Door to Balloon Time. Catheterization and Cardiovascular Interventions, 87 (7), 1194–1200. doi: http://doi.org/10.1002/ccd.26230

Song, F., Yu, M., Yang, J., Xu, H., Zhao, Y., Li, W. et. al. (2016). Symptom-Onset-To-Balloon Time, ST-Segment Resolution and In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in China: From China Acute Myocardial Infarction Registry. The American Journal of Cardiology, 118 (9), 1334–1339. doi: http://doi.org/10.1016/j.amjcard.2016.07.058

Denktas, A. E., Anderson, H. V., McCarthy, J., Smalling, R. W. (2011). Total Ischemic Time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care. JACC: Cardiovascular Interventions, 4 (6), 599–604. doi: http://doi.org/10.1016/j.jcin.2011.02.012

Finnegan, J. R., Meischke, H., Zapka, J. G., Leviton, L., Meshack, A., Benjamin-Garner, R. et. al. (2000). Patient Delay in Seeking Care for Heart Attack Symptoms: Findings from Focus Groups Conducted in Five U.S. Regions. Preventive Medicine, 31 (3), 205–213. doi: http://doi.org/10.1006/pmed.2000.0702

Sederholm Lawesson, S., Isaksson, R.-M., Thylén, I., Ericsson, M., Ängerud, K., Swahn, E. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. International Journal of Cardiology, 264, 7–11. doi: http://doi.org/10.1016/j.ijcard.2018.03.084

Brieger, D., Eagle, K. A., Goodman, S. G., Steg, P. G., Budaj, A., White, K., Montalescot, G. (2004). Acute Coronary Syndromes Without Chest Pain, An Underdiagnosed and Undertreated High-Risk Group. Chest, 126 (2), 461–469. doi: http://doi.org/10.1378/chest.126.2.461


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Published
2021-05-25
How to Cite
Zabashta, V., Fedak, B., & Lobova, I. (2021). Analysis of the hospitalization time impact on hospital mortality from acute myocardial infarction. EUREKA: Health Sciences, (3), 88-94. https://doi.org/10.21303/2504-5679.2021.001813
Section
Medicine and Dentistry