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document
The evolving clinical status of patients after a myocardial infarction : the importance of post-hospital data for mortality prediction . Studies predicting mortality after myocardial infarction ( MI ) usually rely on in-hospital data , and combine patients admitted for the first MI with recurrent MI patients . Since treatment decisions are often made or modified at the first outpatient clinic visit , this study was designed to evaluate the importance of post-hospital data on mortality prediction after a first myocardial infarction ( MI ) . An inception cohort of patients enrolled in the Beta-Blocker in Heart Attack Trial ( n = 2830 ) was included . Forty-three variables ( including in-hospital and post-hospital data ) were evaluated using stepwise logistic regression . Ten variables were independently associated with 1-year mortality : five used in-hospital data ( history of hypertension , hypercholesterolemia , congestive heart failure [ CHF ] , ventricular tachycardia , and age ) ; and five variables depended on post-hospital data collected at the first outpatient visit ( CHF after discharge , New York Heart Association functional class , heart rate , pulmonary rates , and smoking ) . Two predictive systems were developed that partitioned patients into one of four classes with distinct mortality risks : a composite system using the 10 in- and post-hospital variables , and a system using only the 5 in-hospital variables . Mortality risk for the composite system classes ranged from 0.6 to 20.0 % ( I [ n = 861 ] , 0.6 % ; II [ n = 1151 ] , 2.3 % ; III [ n =698 ] , 4.3 % ; IV [ n = 120 ] , 20.0 % ) . In contrast , the range of mortality risk using the in-hospital data only system was less ( 1 to 8.3 % ) . Most importantly , a distinct gradient within each class of the in-hospital data only system was created by the addition of the post-hospital data . This study demonstrates that risk stratification after an acute first MI is improved by the addition of post-hospital data .
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Intervention_Educational
post-hospital data
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Intervention_Educational
in-hospital data
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Intervention_Educational
post-hospital data
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Intervention_Educational
in-hospital and post-hospital data )
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Intervention_Educational
post-hospital data
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Intervention_Educational
in-hospital data
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Intervention_Other
in-hospital data
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Intervention_Educational
post-hospital data
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Intervention_Educational
post-hospital data
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Outcome_Mortality
Mortality risk
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Outcome_Mortality
range of mortality
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Participant_Condition
myocardial infarction ( MI
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Participant_Condition
patients admitted for the first MI with recurrent MI patients
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Participant_Condition
patients enrolled in the Beta-Blocker in Heart Attack Trial
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Participant_Sample-size
2830