among STEMI and non-STEMI Patients, Texas 2018 Texas Council on - PowerPoint PPT Presentation

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

BACKGROUND

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 8/14/2018 3

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. 8/14/2018 4

METHODS

METHODS ➢ 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. 8/14/2018 6

National Guidelines Inclusion Criteria ➢ >18 years old ➢ STEMI & non-STEMI ➢ Arrival via ambulance ➢ With complete records 8/14/2018 7

RESULTS

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 • 8/14/2018 9

Presenting symptoms at first medical contact and in- hospital complications among STEMI vs non-STEMI 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%) 8/14/2018 10

Presenting symptoms at first medical contact among non-STEMI vs STEMI 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. 11 8/14/2018

In-hospital complications among non-STEMI vs STEMI 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 ➢ 8/14/2018 to STEMI and it is significant. 12

Odds of in-hospital deaths among AMI patients with presenting symptoms vs without presenting symptoms. 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. 13 8/14/2018

CONCLUSIONS

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 • 8/14/2018 15

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. 8/14/2018 16

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 Questions? 8/14/2018 17

Thank you Lakshmi Bhargavi Sahini, MBBS, MPH (512) 776-3197 Lakshmi.Sahini@dshs.texas.gov 8/14/2018 18