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In-Hospital Mortality Higher for Homeless Heart Attack Patients

MONDAY, Oct. 26, 2020 -- Homeless individuals are more likely to die from heart attacks while being treated at a hospital than nonhomeless patients, according to a study presented at the annual Canadian Cardiovascular Congress, held virtually from Oct. 21 to 24.

Samantha Liauw, M.D., from the University of Toronto, and colleagues examined data from 2,856 patients presenting with ST-segment elevation myocardial infarction (STEMI) and admitted to an inner-city hospital in Toronto from 2008 to 2017. Patients were categorized as homeless (75 individuals) or not, and demographics, clinical characteristics, and outcomes were compared between the two groups.

The researchers found that in-hospital mortality rates were significantly higher in the homeless versus nonhomeless patients (18.7 versus 5.6 percent). Homeless STEMI patients were significantly younger (58.2 versus 62.7 years) and more likely to be male (95.9 versus 76.5 percent) than nonhomeless patients. Homeless patients smoked at significantly higher rates (83.6 versus 50.4 percent), while blood pressure, cholesterol, and diabetes were similar between the two groups. Homeless patients had more previous or current psychiatric conditions (29 versus 2 percent), as well as higher levels of alcohol abuse (24 versus 1 percent) and cocaine use (15 versus <1 percent). Medical history for coronary artery disease and heart failure were similar between groups, but significantly more homeless patients had peripheral arterial disease (11 versus <3 percent).

"The elevated risk at a younger age could be related to chronic stress from being homeless, higher rates of smoking, poverty, and unreliable access to healthy food," Liauw said in a statement. "Lack of trust in the medical system, poor access to health care for chronic conditions, and slower receipt of emergency therapies may also have contributed."

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Posted: October 2020