Among Medicare beneficiaries undergoing percutaneous coronary intervention (PCI) after having a heart attack, mortality risk more than doubles from the index hospitalization to 90 days post-discharge if they present with one of three co-morbid conditions at the index hospitalization—CHF, severe renal failure or malnutrition.
That was the conclusion of research recently conducted by HealthTrust (via Clinical Data Solutions) and a team of cardiac researchers led by Aaron D. Kugelmass (Baystate Health, Springfield, Massachusetts)—and the information could be used to improve the informed consent process for individuals with any of these co-morbidities who are contemplating the procedure. The research abstract was on display at the 2016 annual meeting of the American College of Cardiology (ACC) in Chicago.
For background, the number of Medicare beneficiaries receiving PCI for ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) increased nearly five percent during the three-year study period (fiscal years 2011 through 2014). This is clearly a reflection of clinical evidence showing survival improvement among heart attack patients, particularly those with STEMI, bring treated via primary PCI within 60 to 90 minutes of symptom onset—as well as more facilities offering the procedure.
Nearly two-thirds of study participants were classified as NSTEMI, mirroring the trend in the general population, and those undergoing other types of revascularization procedures were excluded. The study examined the occurrence of co-morbidities associated with mortality during the index admission, during the first 30 days post-discharge and 31 to 90 days post-discharge. The 90-day mark is a frequent endpoint of an “episode of care” under bundled payment mechanisms.
In addition to elevated mortality risk across all studied time periods among patients presenting with CHF, severe renal failure or malnutrition, the study found:
- Mortality rate (approximately 4 percent) was relatively stable for Medicare beneficiaries undergoing PCI for myocardial infarction during the study period
- Patients presenting with STEMI (vs NSTEMI) had significant adjusted mortality hazard through day 90 post-discharge
- Older white females were more likely to die during the index admission than younger, non-white males, while older, white males were more likely to do so relative to younger, non-white females in the first 30 days post-discharge
- Numerous co-morbid conditions identified at the time of admission were associated with a mortality hazard during the different time periods analyzed; however, the extent of risk associated with these variables changed as time progressed beyond the index hospitalization
Clinical Data Solutions will be involved in follow-up studies to see if it can develop tools to assist with improving outcomes for acute myocardial infarction.