title: Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data.
abstract: Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with asthma compared to the general population have not been studied. A total of 300,161 people were identified with a first MI over the period 2003-2013 in the Myocardial Ischaemia National Audit Project database, of whom 8922 (3%) had asthma. Logistic regression was used to compare presentation, in-hospital care, in-hospital and 180-day post-discharge all-cause mortality in people with and without asthma adjusting for demographics and comorbidities, diagnosis on arrival and secondary prevention. People with asthma were more likely to have a delay in their MI diagnosis following an STEMI (ST-elevation myocardial infarction; odds ratio (OR) 1.38, confidence interval CI 1.06-1.79) but not an nSTEMI (non-ST-elevation myocardial infarction; OR 1.04, CI 0.92-1.17) compared to people without asthma and a delay in reperfusion (OR 1.19, CI 1.09-1.30) following an STEMI. They were much less likely to be discharged on a beta blocker following an STEMI or nSTEMI (OR 0.24, CI 0.21-0.28 and OR 0.27, CI 0.24-0.30, respectively). There was no difference in in-hospital or 180-day mortality (OR 0.98, CI 0.59-1.62 and OR 0.99, CI 0.72-1.36) following an STEMI or nSTEMI (OR 0.89, CI 0.47-1.68 and OR 1.05, CI 0.85-1.28). Although people with asthma were more likely to have a delay in diagnosis following an STEMI but not an nSTEMI compared to the general population, were more likely to have a delay in reperfusion therapy and were much less likely to receive beta blockers following an STEMI or nSTEMI, there was no difference in the prescriptions of other secondary prevention medications. None of the differences in presentation or management were associated with an increase in all-cause in-hospital or 180-day mortality in people with asthma compared to the general population.
authors.affiliation: 1 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Paulo
authors.initials: P
authors.lastname: Pinto
authors.affiliation: 1 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.|2 National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Kieran J
authors.initials: KJ
authors.lastname: Rothnie
authors.affiliation: 3 Faculty of Life Sciences, University College London, London, UK.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Lui
authors.affiliation: 4 Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: 1 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: 1 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.|2 National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Quint
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data*; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D011787:Quality of Health Care; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D006113:United Kingdom
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Asthma; cardiovascular disease; epidemiology; mortality; myocardial infarction; quality of care