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Main arrow Archive of previous Issues arrow ╣5 2014 (39) arrow Medical and social factors affecting hospital mortality from myocardial infarction in heart hospital
Medical and social factors affecting hospital mortality from myocardial infarction in heart hospital Print
Wednesday, 26 November 2014

D.V. Kryuchkov, G.V. Artamonova
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

Abstract. Rates of hospital mortality from myocardial infarction depend upon many factors: clinical profile of patients, diagnostic and treatment methods in use, organization and quality of care in a particular health care setting.

Aim: to identify medical and social factors affecting hospital mortality from myocardial infarction in a specialized heart hospital.

Data and methods. Data for study was continuous retrospective patient database, that includes 4349 patients with myocardial infarction admitted in 2008-2011. Analysis of quantitative data calculated mean and standard deviation (M▒SD using Mann-Whitney test and Kruskal-Wallis test. To compare quality data frequency (F) was calculated using Pearson χ-squared criterion. p <0.05 was accepted as critical level of statistical significance.

Results. In 2008-2011, a total of 536 patients died from myocardial infarction, 57.5% of them - from recurrent infraction. The average age of patients added up to 72.7 ▒ 10.6 years. In 52.0% of cases the cause of death was cardiogenic shock. 48.3% of the dead had a disability status.

In the structure of hospital mortality the share of mortality within 24 hours averaged 33.6▒4.3%. The average level of mortality within 24 hours equals to 4.1▒1.0%.

Hospital mortality was 12.3 ▒2.0%; mortality from myocardial infarction complicated with cardiogenic shock added up to 82.7▒9.6%; mortality from primary myocardial infarction equaled to7.4▒ 1.6% and from recurrent myocardial infarction ľ 23.8▒4.5% (p = 0.0001).

Hospital mortality depends upon patientsĺ age: mortality in patients of working age was 4.9▒0.7%, and 12.7▒2.4% - in patients of retirement age, and 25.7▒5.2% (p=0,0001) in senile age patients.

Hospital mortality rate is higher among women (1.3 ▒ 3.2%) compared to men (9.6 ▒ 1.4, p = 0.0001). Hospital mortality among the disabled patients (14.7 ▒ 3.8%) is higher compared to patients without disability (10.6 ▒ 2.5, p = 0.0001).

Hospital mortality of patients without reperfusion was 16.0▒4.2%, and 8.0▒1.1% (p = 0.0001) - in case of reperfusion.

Conclusion. Factors that negatively affect hospital mortality rates include recurrent myocardial infarction, cardiogenic shock, female gender, disability, old age and conservative patient management.

Keywords: hospital mortality; mortality within 24 hours; myocardial infarction; cardiogenic shock; tactics of treatment of patients.

 

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