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Background: Specialist cardiac care has been shown to reduce inpatient mortality following non-ST segment myocardial infarction (NSTEMI), but whether this benefit extends beyond index admission is unclear., Methods: Using the linked Myocardial Ischaemia National Audit Project (MINAP) registry, and Office for National Statistics mortality recording, we included 425,205 NSTEMI patients admitted to UK hospitals, between January 2005 and March 2019 that survived to discharge. 217,964 (52 %) were admitted to a specialty cardiac ward. Multivariable Cox-regression models were applied to imputed data to estimate Hazard Ratios for mortality over our study period., Results: Patients admitted to specialty cardiology wards were younger (70 years vs. 75), less often female (32 % vs. 40 %) but more often received statins (86 % vs. 84 %) or beta-blockers (83 % vs. 77 %) (all P < 0.001). One-year (aHR:0.84, 95 % CI 0.83-0.86), and ten-year mortality (aHR: 0.88, 95 % CI 0.87-0.89) were lower in patients admitted to specialty cardiac wards, compared to admitted elsewhere (all P < 0.001). There was significant geographic variation in the proportion admitted to speciality cardiac wards (London 59 % vs. East of England 43 %), with over 1700 deaths potentially avoided if the MINAP target of 80 % was reached., Conclusion: Patients admitted to a cardiac ward had significantly lower mortality compared to alternate wards persisting up to ten-years. There is wide regional variation in the proportion of patients who received specialist cardiology care during their admission and an opportunity exists for lives saved if the proportion of NSTEMI patients admitted to a cardiac ward were to reach the MINAP target of 80 %., Competing Interests: Declaration of competing interest NW's research fellowship is funded by Abbott Vascular., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Aims: The long-term outcomes of out of hospital cardiac arrest (OHCA) survivors are not well known., Methods and Results: Using the Myocardial Ischaemia National Audit Project (MINAP) registry, linked to Office for National Statistics mortality data, we analysed 661 326 England, Wales, and Northern Ireland acute myocardial infarction (AMI) patients; 14 127 (2%) suffered OHCA and survived beyond 30 days of hospitalization. Patients dying within 30 days of admission were excluded. Mean follow-up for the patients included was 1500 days. Cox regression models were fitted, adjusting for demographics and management strategy. OHCA survivors were younger (in years) {64 [interquartile range (IQR) 54-72] vs. 70 (IQR 59-80), P < 0.001}, more often underwent invasive coronary angiography (88% vs. 71%, P < 0.001) and percutaneous coronary intervention (72% vs. 45%, P < 0.001). Overall, the risk of mortality for OHCA patients that survived past 30 days was lower than patients that did not suffer cardiac arrest [adjusted hazard ratio (HR) 0.91; 95% CI; 0.87-0.95, P < 0.001]. 'Excellent care' according to the mean opportunity-based quality indicator (OBQI) score compared to 'Poor care', predicted a reduced risk of long-term mortality post-OHCA for all patients (HR: 0.77, CI; 0.76-0.78, P < 0.001), more for STEMI patients (HR: 0.73, CI; 0.71-0.75, P < 0.001), but less significantly in NSTEMI patients (HR: 0.79, CI; 0.78-0.81, P < 0.001)., Conclusion: OHCA patients remain at significant risk of mortality in-hospital. However, if surviving over 30 days post-arrest, OHCA survivors have good longer-term survival up to 10 years compared to the general AMI population. Higher-quality inpatient care appears to improve long-term survival in all OHCA patients, more so in STEMI., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Acute myocardial infarction with cardiogenic shock (AMI-CS) carries a significant risk of inpatient mortality compared with AMI alone, although it is unclear what the longer-term outcomes of AMI-CS survivors is, and whether the inpatient quality of care received influences this., Methods: Using the Myocardial Ischaemia National Audit Project (MINAP) registry, linked to Office for National Statistics (ONS) mortality data, we analyzed 330,517 UK AMI patients; 3330 (1 %) with CS. Patients dying within thirty-days of admission were excluded. Median follow-up for patients included was 1642 days. Cox regression models were fitted, adjusting for demographics and management strategy., Results: AMI-CS survivors were younger (median years) (67 vs. 69, p < 0.001), less often female (29 % vs. 32 %, p < 0.001) and more likely to present with STEMI (81 % vs. 37 %, p < 0.001). Mortality risk was highest at one-year for AMI-CS survivors compared to patients that did not suffer CS (adjusted hazard ratio [HR] 1.85; 95 % CI; 1.68-2.04, p < 0.001), and remained elevated at five-years (HR 1.55; 95 % CI; 1.43-1.68, p < 0.001). 'Excellent-care' according to mean opportunity-based quality indicator (OBQI) score compared to 'Poor-care', showed reduced risk of long-term mortality with AMI-CS (HR: 0.46, CI; 0.39-0.54, P < 0.001). Of patients that received "Excellent-care", AMI-CS survivors had elevated risk of long-term mortality (HR 1.45, 95 % CI; 1.34-1.57, P < 0.001)., Conclusion: AMI-CS survivors have elevated risk long-term mortality risk when compared with AMI patients, which persists beyond five years. AMI-CS patients that receive higher-quality inpatient care have better longer-term survival compared to those with poorer inpatient care., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NW's research fellowship is funded by Abbot Vascular., (Copyright © 2024. Published by Elsevier B.V.)