Quality of Care and Long-term Survival After ST-elevation Myocardial Infarction in Adults with Cancer.

IF 4.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Quality of Care and Clinical Outcomes Pub Date : 2025-02-27 DOI:10.1093/ehjqcco/qcaf004

Mohamed Dafaalla, Jan Walter Dhillon Shanmuganathan, Harindra C Wijeysundera, Derek J Roberts, Safi U Khan, Ayman Elbadawi, Islam Y Elgendy, Phillip Freeman, Christian Mallen, Mamas A Mamas

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引用次数: 0

Abstract

Background: While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge.

Methods: A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project (MINAP) and UK national Hospital Episode Statistics Admitted Patient Care (HES APC) registries. We used the composite opportunity-based quality indicator (OBQI) to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves.

Results: In total, 6 787 STEMI indexed admissions with cancer were identified. Of those, 4 340 (63.9%) patients received optimum care, 1 320 (19.5%) intermediate care, and 1 127(25.2%) low care quality. Patients with low care quality were older (optimum quality median (IQR) = 72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)) and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days (HR 7.0, 95% CI 5.7-8.7), 1 year (HR 4.0, 95% CI 3.6-4.4), and 5 years (HR 2.6, 95% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67-102), 508 (95% CI 468-548), and 1096 (95% CI 1034-1158) at 30 days, one year, and five years respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions.

Conclusion: Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.

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成人癌症患者st段抬高型心肌梗死后的护理质量和长期生存。

背景：虽然目前的证据表明，st段抬高型心肌梗死（STEMI）的临床结果在癌症患者中更差，但尚不清楚入院时接受的护理质量在其中起什么作用。我们的目的是评估护理质量与患者出院后生存之间的关系。方法：从英国心肌梗死国家审计项目（MINAP）和英国国家医院事件统计入院患者护理（HES APC）登记处获得STEMI患者的全国相关队列（2005年1月至2019年3月）。我们使用基于机会的综合质量指标（OBQI）来衡量整体护理质量。采用Cox比例风险模型、Kaplan-Meier和累积生存曲线评估生存结果。结果：共确定了6787例STEMI索引的癌症入院患者。其中，4 340例（63.9%）患者接受最佳护理，1 320例（19.5%）接受中等护理，1 127例（25.2%）接受低质量护理。护理质量低的患者以老年人(最佳质量中位数(IQR) = 72.8（65.1, 79.6）、中等质量中位数（75.5,67.9,82.1）、低质量中位数（78.2,69.2,84.7）为主，女性（最佳质量21.6%、中等质量27.3%、低质量35.5%）较多。与最佳护理的患者相比，低护理质量的患者在30天（HR 7.0, 95% CI 5.7-8.7）、1年（HR 4.0, 95% CI 3.6-4.4）和5年（HR 2.6, 95% CI 2.4-2.8）的死亡风险更高。相对生存分析显示，在30天、1年和5年期间，接受最佳护理的患者在全国范围内存活的人数分别为84人（95% CI 67-102）、508人（95% CI 468-548）和1096人（95% CI 1034-1158）。在西北和东北地区，护理质量与生存之间的关系更为深刻。结论：STEMI合并癌症患者的护理质量与短期和长期生存密切相关。提高护理质量可以在短期和长期内挽救成百上千人的生命。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal - Quality of Care and Clinical Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

3.80%

发文量

期刊介绍： European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.