Similar to the American Heart Association study, the JAMA article reported that STEMI inpatients had higher death rates, longer hospital stays that cost more, and patients were less likely to receive timely, specialized care than STEMI outpatients.
Inpatient challenges
I've practiced both inpatient and ER medicine and understand the added challenges of managing inpatient heart attacks. In the ER, all of the staff is attuned to the various signs and symptoms of a heart attack and are quick to get an ECG and trigger a referral to the cardiac catheterization lab, when necessary.
On the inpatient floor, however, the staff caring for non-cardiac patients is not as used to quickly identifying and managing heart attacks. These patients typically have many other medical issues that distract the staff from a rapid diagnosis of heart problems.
Also, the attending doctor may not be readily available. The American Heart Association study found that only one-third of patients, mostly women, reported classic symptoms of chest pain and shortness of breath. All of these issues conspire to delay inpatient diagnosis and treatment.
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