When a person has a heart attack and is taken to the hospital, there are well organized practices in place to help re-open blocked arteries.

But when a patient has a heart attack while staying in the hospital for an unrelated health issue, their risk of dying may be higher.

A new study at the University of North Carolina, Chapel Hill and published in the Journal of the American Medical Association, looked at the outcomes of patients who experience a certain type of heart attack while admitted to the hospital.

Early restoration of blood flow with percutaneous coronary intervention (PCI; a procedure such as stent placement used to open narrowed coronary arteries) or administration of medication to dissolve a clot remains the primary goal in the initial treatment of eligible patients presenting to a hospital with ST-elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack).

According to background information on the published study, over the last decade, recognition that this strategy is of critical importance has prompted the development of a number of regional and national initiatives to facilitate and improve systems of care for STEMI. These initiatives have focused exclusively on patients who develop STEMI outside of a hospital setting, and little is known about the incidence and outcomes of STEMI in patients hospitalized for non-acute coronary syndrome conditions.

The study included an analysis of STEMIs between 2008 and 2011. A total of 62,021 STEMIs were identified in 303 hospitals, of which 3,068 occurred in patients hospitalized for non-acute coronary indications.

Researchers found that patients developing inpatient-onset STEMI had more than three-fold greater in-hospital deaths than those with outpatient-onset STEMI, or 33.6 percent verses 9.2 percent. Patients with inpatient-onset STEMI were less likely to be discharged home, and were less likely to undergo cardiac catheterization

Dr. Gary MacKenzie, a cardiologist at McKay-Dee Hospital, said patients who are admitted to the hospital for non-cardiac causes and who have a heart attack in the hospital may have had a previous heart history or may have no history of heart disease. However, they are usually older patients who are ill from some other major illness such as pneumonia, gastrointestinal hemorrhage, kidney failure, hip fracture, other major trauma, recent stroke or major surgery.

“They will have a higher incidence of risk factors such as diabetes or high blood pressure. In this setting the stress of their illness or surgery can precipitate a heart attack and in this setting the mortality risk is high,” he said. “Illnesses such as pneumonia or major surgery or blood loss anemia increase the risk of heart attack not only because of demand stress but because the acute inflammatory reaction in the body can increase the risk of clotting hence the coronary thrombosis.”

MacKenzie said it should seem logical that an elderly patient with a recent hip fracture and pneumonia would have a higher mortality if they have a heart attack than a patient presenting with a heart attack without these associated conditions.

According to Healthgrades.com, McKay-Dee Hospital, Ogden Regional Medical Center and Lakeview Hospital all received a five star rating when it comes to favorable outcomes for patients suffering a heart attack while in the hospital. Davis Hospital and Medical Center received three stars.

Davis Hospital and Medical Center registered nurse and quality control director Rebecca Holgreen, agreed and said many patients may even have congestive heart failure, cancer, valve disease and peripheral vascular disease.

“Additionally, may of the in-hospital STEMI patients may not be candidates for cardiac catheterization based on their co-morbid conditions, identified risk factors, anticoagulation status and family wishes,” she said.

Holgreen said rapid response teams at the hospital work to improve the recognition and response to changes in a patient’s condition so early and rapid intervention can promote and improve outcomes in these patients.

MacKenzie said McKay-Dee screens people at risk for heart attack, although not everyone can be predicted.

“Naturally, for people admitted to hospital for other severe illnesses or emergency or non- elective surgery we can do our best to monitor them but a cardiac complication may occur in any hospital,” he said.