Quality of care and long-term survival after ST-elevation myocardial infarction in adults with cancer

Mohamed Dafaalla; Jan Walter Dhillon Shanmuganathan; Muhammad Rashid; Harindra C. Wijeysundera; Derek J. Roberts; Safi U. Khan; Ayman Elbadawi; Islam Y. Elgendy; Phillip Freeman; Christian Mallen; Mamas A. Mamas

doi:10.1093/ehjqcco/qcaf004

Quality of care and long-term survival after ST-elevation myocardial infarction in adults with cancer

Mohamed Dafaalla, Jan Walter Dhillon Shanmuganathan, Muhammad Rashid, Harindra C. Wijeysundera, Derek J. Roberts, Safi U. Khan, Ayman Elbadawi, Islam Y. Elgendy, Phillip Freeman, Christian Mallen, Mamas A. Mamas

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge. Methods and results A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project and UK national Hospital Episode Statistics Admitted Patient Care registries. We used the composite opportunity-based quality indicator to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves. In total, 6787 STEMI indexed admissions with cancer were identified. Of those, 4340 (63.9%) patients received optimum care, 1320 (19.5%) intermediate care, and 1127(25.2%) low care quality. Patients with low care quality were older [optimum quality median (IQR) = 72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)] and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days [hazard ratio (HR) 7.0, 95% confidence interval (CI) 5.7-8.7], 1 year (HR 4.0, 95% CI 3.6-4.4), and 5 years (HR 2.6, 95% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67-102), 508 (95% CI 468-548), and 1096 (95% CI 1034-1158) at 30 days, 1 year, and 5 years, respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions. Conclusion Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.

Original language	English
Pages (from-to)	934-945
Number of pages	12
Journal	European Heart Journal - Quality of Care and Clinical Outcomes
Volume	11
Issue number	7
DOIs	https://doi.org/10.1093/ehjqcco/qcaf004
State	Published - Nov 1 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.

Funding

This study is funded by the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Funders	Funder number
National Institute for Health and Care Research
Birmingham Biomedical Research Centre
NIHR Imperial Biomedical Research Centre

Keywords

Cancer
Outcomes
Quality of care

ASJC Scopus subject areas

Health Policy
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ehjqcco/qcaf004

Cite this

Dafaalla, M., Shanmuganathan, J. W. D., Rashid, M., Wijeysundera, H. C., Roberts, D. J., Khan, S. U., Elbadawi, A., Elgendy, I. Y., Freeman, P., Mallen, C., & Mamas, M. A. (2025). Quality of care and long-term survival after ST-elevation myocardial infarction in adults with cancer. European Heart Journal - Quality of Care and Clinical Outcomes, 11(7), 934-945. https://doi.org/10.1093/ehjqcco/qcaf004

@article{0edc4544e7b34048b61f0193f858eb12,

title = "Quality of care and long-term survival after ST-elevation myocardial infarction in adults with cancer",

abstract = "Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge. Methods and results A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project and UK national Hospital Episode Statistics Admitted Patient Care registries. We used the composite opportunity-based quality indicator to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves. In total, 6787 STEMI indexed admissions with cancer were identified. Of those, 4340 (63.9\%) patients received optimum care, 1320 (19.5\%) intermediate care, and 1127(25.2\%) low care quality. Patients with low care quality were older [optimum quality median (IQR) = 72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)] and more frequently women (optimum quality 21.6\%, intermediate quality 27.3\%, low quality 35.5\%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days [hazard ratio (HR) 7.0, 95\% confidence interval (CI) 5.7-8.7], 1 year (HR 4.0, 95\% CI 3.6-4.4), and 5 years (HR 2.6, 95\% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95\% CI 67-102), 508 (95\% CI 468-548), and 1096 (95\% CI 1034-1158) at 30 days, 1 year, and 5 years, respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions. Conclusion Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.",

keywords = "Cancer, Outcomes, Quality of care",

author = "Mohamed Dafaalla and Shanmuganathan, \{Jan Walter Dhillon\} and Muhammad Rashid and Wijeysundera, \{Harindra C.\} and Roberts, \{Derek J.\} and Khan, \{Safi U.\} and Ayman Elbadawi and Elgendy, \{Islam Y.\} and Phillip Freeman and Christian Mallen and Mamas, \{Mamas A.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2025",

month = nov,

day = "1",

doi = "10.1093/ehjqcco/qcaf004",

language = "English",

volume = "11",

pages = "934--945",

journal = "European Heart Journal - Quality of Care and Clinical Outcomes",

issn = "2058-5225",

publisher = "Oxford University Press",

number = "7",

}

Dafaalla, M, Shanmuganathan, JWD, Rashid, M, Wijeysundera, HC, Roberts, DJ, Khan, SU, Elbadawi, A, Elgendy, IY, Freeman, P, Mallen, C & Mamas, MA 2025, 'Quality of care and long-term survival after ST-elevation myocardial infarction in adults with cancer', European Heart Journal - Quality of Care and Clinical Outcomes, vol. 11, no. 7, pp. 934-945. https://doi.org/10.1093/ehjqcco/qcaf004

TY - JOUR

T1 - Quality of care and long-term survival after ST-elevation myocardial infarction in adults with cancer

AU - Dafaalla, Mohamed

AU - Shanmuganathan, Jan Walter Dhillon

AU - Rashid, Muhammad

AU - Wijeysundera, Harindra C.

AU - Roberts, Derek J.

AU - Khan, Safi U.

AU - Elbadawi, Ayman

AU - Elgendy, Islam Y.

AU - Freeman, Phillip

AU - Mallen, Christian

AU - Mamas, Mamas A.

PY - 2025/11/1

Y1 - 2025/11/1

N2 - Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge. Methods and results A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project and UK national Hospital Episode Statistics Admitted Patient Care registries. We used the composite opportunity-based quality indicator to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves. In total, 6787 STEMI indexed admissions with cancer were identified. Of those, 4340 (63.9%) patients received optimum care, 1320 (19.5%) intermediate care, and 1127(25.2%) low care quality. Patients with low care quality were older [optimum quality median (IQR) = 72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)] and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days [hazard ratio (HR) 7.0, 95% confidence interval (CI) 5.7-8.7], 1 year (HR 4.0, 95% CI 3.6-4.4), and 5 years (HR 2.6, 95% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67-102), 508 (95% CI 468-548), and 1096 (95% CI 1034-1158) at 30 days, 1 year, and 5 years, respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions. Conclusion Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.

AB - Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge. Methods and results A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project and UK national Hospital Episode Statistics Admitted Patient Care registries. We used the composite opportunity-based quality indicator to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves. In total, 6787 STEMI indexed admissions with cancer were identified. Of those, 4340 (63.9%) patients received optimum care, 1320 (19.5%) intermediate care, and 1127(25.2%) low care quality. Patients with low care quality were older [optimum quality median (IQR) = 72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)] and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days [hazard ratio (HR) 7.0, 95% confidence interval (CI) 5.7-8.7], 1 year (HR 4.0, 95% CI 3.6-4.4), and 5 years (HR 2.6, 95% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67-102), 508 (95% CI 468-548), and 1096 (95% CI 1034-1158) at 30 days, 1 year, and 5 years, respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions. Conclusion Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.

KW - Cancer

KW - Outcomes

KW - Quality of care

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DO - 10.1093/ehjqcco/qcaf004

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AN - SCOPUS:105020946731

SN - 2058-5225

VL - 11

SP - 934

EP - 945

JO - European Heart Journal - Quality of Care and Clinical Outcomes

JF - European Heart Journal - Quality of Care and Clinical Outcomes

IS - 7

ER -

Quality of care and long-term survival after ST-elevation myocardial infarction in adults with cancer

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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