# The quality of care and long-term mortality of patients with ST-elevation myocardial infarction and cardiac devices: a nationwide cohort study

## TL;DR

This study finds that patients with cardiac devices who experience heart attacks receive lower quality care and face higher long-term mortality risks.

## Contribution

The study is the first to examine the impact of cardiac devices on STEMI care quality and long-term mortality on a nationwide scale.

## Key findings

- Patients with cardiac devices were less likely to receive timely reperfusion therapy for heart attacks.
- These patients had a higher risk of all-cause mortality at 5 years, even after excluding early deaths.
- The findings highlight disparities in care and outcomes for STEMI patients with cardiac devices.

## Abstract

There is a growing population with cardiac devices (pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy), but whether this influences quality of care and long-term mortality after ST-elevation myocardial infarction (STEMI) is unknown.

Patients in England and Wales between January 2005 and March 2019 with a diagnosis of STEMI were included from the Myocardial Ischaemia National Audit Project, Hospital Episode Statistics and mortality linkage to July 2021. Primary outcomes were all-cause mortality over the study period, secondary outcomes were odds of undergoing reperfusion within guideline mandated timeframes. Multivariate cox-models compared all-cause mortality over specified time-periods and logistic regression models illustrated odds of undergoing reperfusion. 322 890 patients with STEMI were included, 2118 (0.7%) had a cardiac device at STEMI admission. Patients with cardiac devices were older (78 years old vs. 66 years old) and more often female (32% vs. 29%) (P < 0.001). After multivariate adjustment, patients with cardiac devices were less likely to have a ‘door-to-balloon time’ of under 60 min (aOR 0.61 95% CI 0.54–0.70) (P < 0.001). Patients with cardiac devices had an increased risk of all-cause mortality at 5-years (aHR 1.12 95% CI 1.05–1.20) (P < 0.001). Excluding patients dying within 30 days of admission, patients with cardiac devices still had a higher risk of death at 5-years (aHR 1.23 95% CI 1.13–1.33) (all P < 0.001).

Patients with cardiac devices were less likely to undergo revascularization for STEMI within guideline mandated timeframes. They remain at elevated risk of all-cause mortality up to 5-years compared with STEMI patients without cardiac devices.

Graphical Abstract