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European Heart Journal 2000 21(3):213-219; doi:10.1053/euhj.1999.1758
Copyright © 2000 by the European Society of Cardiology.
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Identifying the risk of death following hospital discharge in patients admitted with a suspected acute myocardial infarction in whom the diagnosis is not confirmed

C Packhama,f1, D Grayb, P Silcocksc and J Hamptonb

a University Division of Public Health Medicine and Epidemiology, Queens Medical Centre, Nottingham, U.K.
b University Division of Cardiovascular Medicine, Queens Medical Centre, Nottingham, U.K.
c Trent Institute of Health Services Research, Queens Medical Centre, Nottingham, U.K.

revised June 11, 1999; accepted June 16, 1999

Abstract

Aims To describe clinical factors, available at the time of discharge, that predicted survival of patients admitted with a suspected acute myocardial infarction in whom the diagnosis was not confirmed.

Methods and Results A cohort study based on the Nottingham Heart Attack Register of 1716 sequential patients discharged alive from two acute teaching hospitals following admission in 1992. The main outcome was identification of high and low mortality risk groups over 5 years of follow-up. Overall 5-year survival was 58% (95% CI 56 to 60%). Having abnormal cardiac enzyme changes or an abnormal ECG that was insufficient to meet established diagnostic criteria of myocardial infarction, or both, identified three groups with a 5 year survival of 77%, 60% or 51%. Multivariate methods were used to develop a risk score from seven variables available at the time of discharge (age, sex, past history of myocardial infarction, ECG abnormalities, cardiac enzyme abnormalities, Killip score of 2 or 3 on admission and being discharged on a diuretic). Quartiles of this risk score then identified four groups with 5 year survival ranging from 89% to 25%.

Conclusion Among the study cohort, it was possible to identify subgroups with a markedly different risk of subsequent mortality from clinical indicators that were readily available at the time of hospital discharge. Risk stratification has the potential to improve targeting of subsequent secondary preventive efforts, but further work is required to ascertain whether cardiovascular risk can be modified through a more intensive approach to management.

Key Words: Suspected myocardial infarction, survival, risk stratification

f1 Correspondence: Dr C. J. Packham, University Division of Public Health Medicine and Epidemiology, Queens Medical Centre, Nottingham, NG7 2UH, U.K.

References

  1. Hampton J, Gray A. The future of general medicine: lessons from an admissions ward. J Roy Coll of Physicians. 1998;32:39–43
  2. Brown N, Young T, Gray D, Skene AM, Hampton JR. Inpatient deaths from acute myocardial infarction, 1982–92 analysis of data in the Nottingham heart attack register. Br Med J. 1997;315:159–164[Abstract/Free Full Text]
  3. Tunstall-Pedoe H. Perspectives on trends in mortality and case fatality from coronary heart attacks: the need for a better definition of acute myocardial infarction. Heart. 1998;80:112–113[Free Full Text]
  4. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas A-M, Pajak A. Myocardial infarction and coronary deaths in the World Health Organisation MONICA project. Circulation. 1994;90:583–612[Abstract/Free Full Text]
  5. Wilcox RG, Roland JM, Hampton JR. Prognosis of patients with ‘chest pain? cause’. Br Med J. 1981;282:431–433[ISI][Medline]
  6. Rowley JM, Mouser P, Harrison EA, Skene AM, Hampton JR. Management of myocardial infarction: implications for current policy derived from the Nottingham Heart Attack Register. Br Heart J. 1992;67:255–262[Abstract/Free Full Text]
  7. Launbjerg J, Fruergaard P, Jacobsen HL, Masden JK. Long term risk factors from non-invasive evaluation of patients with acute chest pain, but without myocardial infarction. Eur Heart J. 1995;16:30–37[Medline]
  8. Packham C, Gray D, Silcocks P, Brown N, Melville M, Hampton J. Mortality of patients admitted with a suspected acute myocardial infarction in whom the diagnosis is not confirmed. Eur Heart J. 1999;:
  9. Townsend P, Phillmore P, Beattie A. Health and Deprivation: inequality in the North. London: Croom Helm; 1988.
  10. Woodward M. Small area statistics as markers for personal social status in the Scottish heart health study. J Epid Comm Health. 1996;50:570–576[Abstract]
  11. Scrivener G, Lloyd DCE. Allocating census data to general practice populations: implications for study of prescribing variation at practice level. Br Med J. 1995;311:163–165[Abstract/Free Full Text]
  12. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481[CrossRef][ISI]
  13. Cox DR. Regression models and life tables. J R Stat Soc[B]. 1972;32:187–220
  14. SPSS for Windows version 8.0.0. Chicago: SPSS Inc; 1997.
  15. Harrell FE, Califf RM, Pryor DB, Lee K, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247:2543–2546[Abstract]
  16. Weatherall DJ, Ledingham JGG, Warrell DA. Oxford Textbook of Medicine. Oxford: Oxford University Press; 1996.
  17. De Bono D, Hopkins A. The management of acute myocardial infarction: guidelines and audit standards. Report of a workshop of the Joint Audit Committee of the British Cardiac Society and the Royal College of Physicians. J Roy Coll Physicians Lond. 1994;28:312–317[ISI][Medline]
  18. N Engl J Med. 1983;309:331–336[Abstract]
  19. Millane T, Hearing S, Jones P, Brooks N. Two ECGs and a history: a guide to early hospital discharge of patients with ‘chest pain’? cause. J Roy Coll Physicians Lond. 1998;32:122–124[ISI][Medline]
  20. Mayou R, Bryant B, Forfar C, Clark D. Non-cardiac chest pain and benign palpitations in the cardiac clinic. Br Heart J. 1994;72:548–553[Abstract/Free Full Text]

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