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Comparison of Heart Failure and Cardiac Arrest events among STEMI and non-STEMI Patients, Texas 2018 Texas Council on Cardiovascular Disease and Stroke Quarterly Meeting, Austin Lakshmi Bhargavi Sahini, MBBS, MPH Epidemiologist II Texas

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Comparison of Heart Failure and Cardiac Arrest events among STEMI and non-STEMI Patients, Texas

2018 Texas Council on Cardiovascular Disease and Stroke Quarterly Meeting, Austin

Lakshmi Bhargavi Sahini, MBBS, MPH Epidemiologist II Texas Department of State Health Services

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BACKGROUND

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BACKGROUND

➢Heart failure (HF) and Cardiac arrest (CA) as in- hospital complications post myocardial infarction (MI) ➢HF and CA also as presenting symptoms between first medical contact (FMC) and hospital admission. ➢HF: leading cause of readmissions among MI patients in Texas

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AIM

➢ Compare the incidence of HF and CA as presenting symptoms between STEMI and non- STEMI patients. ➢ Compare the incidence of HF and CA as in- hospital complications between STEMI and non-STEMI patients. ➢ If presenting symptoms (HF & CA) were associated with increased in-hospital mortality among acute myocardial infarction (AMI) patients.

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METHODS

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METHODS

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➢Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry database (Texas) ➢2008 – 2016 ➢Logistic Regression Analysis ➢SAS 9.4 ➢Adjusted odds ratios ➢Confounding variables: Age, gender, hypertension, diabetes, dyslipidemia, smoking history, heart rate and systolic blood pressure at FMC, prior MI, prior HF and prior cardiovascular disease.

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National Guidelines

Inclusion Criteria ➢ >18 years old ➢ STEMI & non-STEMI ➢ Arrival via ambulance ➢ With complete records

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RESULTS

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RESULTS

➢ Total Sample Size = 40,207

STEMI Patients = 12,826 (31.9%)
Non-STEMI Patients = 27,381 (68.1%)

➢ Demographic characteristics

Median age = 60 years (STEMI), 65 years (non-

STEMI)

Gender = 62% men (STEMI), 72% men (non-

STEMI)

Race = 81%- 83% white

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Presenting symptoms at first medical contact and in- hospital complications among STEMI vs non-STEMI

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STEMI non-STEMI HF at First Medical Contact Yes 1,004 (7.8%) 4,640 (17.0%) No 11,822 (92.2%) 22,741 (83.0%) CA at First Medical Contact Yes 781 (6.1%) 371 (1.4%) No 12,045 (93.9%) 27,010 (98.6%) In-hospital complication of HF Yes 1,063 (8.3%) 2,076 (7.6%) No 11,763 (91.7%) 25,305 (92.4%) In-hospital complication of CA Yes 827 (6.5%) 689 (2.5%) No 11,999 (93.5%) 26,692 (97.5%)

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Presenting symptoms at first medical contact among non-STEMI vs STEMI

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Presenting Symptoms Odds Ratio Lower 95% CI Upper 95% CI HF at FMC 1.60 1.48 1.74 CA at FMC 0.26 0.22 0.29

➢ HF at first medical contact: 60% higher in non-STEMI compared to STEMI and it is significant. ➢ CA at first medical contact: 74% lower in non-STEMI compared to STEMI and it is significant.

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In-hospital complications among non-STEMI vs STEMI

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In-hospital Complications Odds Ratio Lower 95% CI Upper 95% CI HF 0.68 0.63 0.74 CA 0.40 0.36 0.45

➢ In-hospital complication of HF: 32% lower in non-STEMI compared to STEMI and it is significant. ➢ In-hospital complication of CA: 60% lower in non-STEMI compared to STEMI and it is significant.

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Odds of in-hospital deaths among AMI patients with presenting symptoms vs without presenting symptoms.

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Odds of in-hospital deaths Odds Ratio Lower 95% CI Upper 95% CI HF at FMC vs patients without HF at FMC 1.44 1.25 1.65 CA at FMC vs patients without CA at FMC 5.85 4.91 6.97

➢ In-hospital Deaths: 44% higher among AMI patients with HF at first medical contact compared to those without HF at FMC. ➢ In-hospital Deaths: Nearly 6 times higher among AMI patients with CA at first medical contact compared to those without CA at FMC.

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CONCLUSIONS

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CONCLUSIONS

➢More common in non-STEMI patients compared to STEMI:

Heart failure at first medical contact

➢More common in STEMI compared to non-STEMI :

Cardiac arrest at first medical contact
In-hospital complications of HF and CA

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CONCLUSIONS (Cont’d)

➢Patients with HF and CA at FMC: Significantly higher in-hospital mortality compared to those without. ➢Improved strategies and interventions are required to reduce mortality rates in high risk subgroups.

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Acknowledgements

➢Nimisha Bhakta, MPH

Director, Health Promotion and Chronic Disease Section Interim Manager, Chronic Disease Epidemiology Texas Department of State Health Services

➢Karen Nunley, PhD

Epidemiologist Team Lead Chronic Disease Epidemiology Branch Health Promotion and Chronic Disease Prevention Section Texas Department of State Health Services

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Questions?

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Thank you

Lakshmi Bhargavi Sahini, MBBS, MPH (512) 776-3197 Lakshmi.Sahini@dshs.texas.gov

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