An unbelievable ordeal: The experiences of adult survivors treated with extracorporeal membrane oxygenation.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a rescue treatment option for adult patients with severe cardiac dysfunction or respiratory failure. While short-term patient outcomes, such as in-hospital mortality and complications, have been widely described, little is known about the illness or recovery experience from the perspectives of survivors. Subjective reports of health are important indicators of the full, long-term impact of critical illness and treatment with ECMO on survivors' lives. OBJECTIVE: The objective of this study was to describe the experiences and needs of adults treated with ECMO, from onset of illness symptoms through the process of survivorship. METHODS: This study was guided by the qualitative method of interpretive description. We conducted in-depth, semistructured interviews with 16 adult survivors of ECMO who were treated at two participating regional ECMO centres in the northeast United States. Additional data were collected from demographic questionnaires, field notes, memos, and medical record review. Development of interview guides and data analysis were informed by the Family Management Style Framework. Qualitative data were analysed using thematic analysis techniques. RESULTS: The sample (n = 16) included 75% male participants; ages ranged from 23 to 65 years. Duration from hospital discharge to interviews ranged from 11 to 90 (M = 54; standard deviation = 28) months. Survivors progressed through three stages: Trauma and Vulnerability, Resiliency and Recovery, and Survivorship. Participants described short- and long-term impacts of the ECMO experience: all experienced physical challenges, two-thirds had at least one psychological or cognitive difficulty, and 25% were unable to return to work. All were deeply influenced by their own specific contexts, family support, and interactions with healthcare providers. CONCLUSIONS: The ECMO experience is traumatic and complex. Recovery requires considerable time, perseverance, and support. Long-term sequelae include impairments in cognitive, mental, emotional, physical, and social health. Survivors could likely benefit from specialised posthospital health services that include integrated, comprehensive follow-up care.

Critical care nurses' clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study.

AIMS AND OBJECTIVES: To explore clinical reasoning about alarm customisation among nurses in intensive care units. BACKGROUND: Critical care nurses are responsible for detecting and rapidly acting upon changes in patients' clinical condition. Nurses use medical devices including bedside physiologic monitors to assist them in their practice. Customising alarm settings on these devices can help nurses better monitor their patients and reduce the number of clinically irrelevant alarms. As a result, customisation may also help address the problem of alarm fatigue. However, little is known about nurses' clinical reasoning with respect to customising physiologic monitor alarm settings. DESIGN: This article is an in-depth report of the qualitative arm of a mixed methods study conducted using an interpretive descriptive methodological approach. METHODS: Twenty-seven nurses were purposively sampled from three intensive care units in an academic medical centre. Semi-structured interviews were conducted by telephone and were analysed using thematic analysis. Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines were used. RESULTS: Four themes were identified from the interview data: unit alarm culture and context, nurse attributes, motivation to customise and customisation "know-how." A conceptual model demonstrating the relationship of these themes was developed to portray the factors that affect nurses' customisation of alarms. CONCLUSIONS: In addition to drawing on clinical data, nurses customised physiologic monitor alarms based on their level of clinical expertise and comfort. Nurses were influenced by the alarm culture on their clinical unit and colleagues' and patients' responses to alarms, as well as their own technical understanding of the physiologic monitors. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be used to design strategies to support the application of clinical reasoning to alarm management, which may contribute to more appropriate alarm customisation practices and improvements in safety.

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association.

BACKGROUND AND PURPOSE: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. METHODS: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. RESULTS: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. CONCLUSIONS: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

Physical and psychological effects of Qigong exercise in community-dwelling older adults: An exploratory study.

Older adults need exercise programs that correspond to age-related changes. The purpose of this study was to explore preliminary effects of an 8-week Qigong exercise intervention on the physical ability, functional and psychological health, and spiritual well-being of community-dwelling older adults. Forty-five community-dwelling adults with the mean age of 74.8 years participated a 1-h Health Qigong exercise session twice weekly for 8 weeks. The majority were female (84%) and white (91%), and lived with their spouse (49%). Physical ability (p < 0.001), functional health (p = 0.001), balance (p < 0.001), functional reach (p < 0.001), depression (p = 0.005), and spiritual well-being (p = 0.004) improved significantly after the 8-week intervention. Most participants perceived physical ability, mental health, and spiritual well-being benefits. No adverse events were reported. A twice weekly Qigong exercise program over 8 weeks is feasible and has potential to improve physical ability, functional health, balance, psychological health, and spiritual well-being in older adults.

Pressure Injury in a Community Population: A Descriptive Study.

PURPOSE: The purpose of this study was to describe present-on-admission pressure injuries (POA-PIs) in community-dwelling adults admitted to acute care. The specific aims of the study were to (1) measure the prevalence of POA-PIs during a 1-year period; (2) determine prehospital location of patients with POA-PIs; and (3) describe demographics, pressure injury (PI) characteristics, risk factors, and posthospital outcome of community-dwelling adults with PIs admitted to hospital. DESIGN: Retrospective descriptive study. SUBJECTS AND SETTING: The study sample was identified from a PI registry, a database maintained for quality improvement, at an 860-bed urban academic medical center in New England. The majority (n = 1022, 76.1%) were admitted to hospital from the community; and the remaining (23.9%) were admitted from long-term care facilities. METHODS: All subjects were assessed by certified wound nurses. Data were extracted electronically from selected standardized electronic health record (EHR) fields, representing variables of interest. Descriptive statistics were analyzed using percentages, means, and medians. RESULTS: The prevalence of patients admitted to acute care with a POA-PI was 7.4%. Community-dwelling subjects with POA-PIs had a mean age of 72.7 ± 15.4 years; 52.4% were male, 80.3% white, 30.9% lived alone, 99.2% were insured, and 30.6% were college educated. They presented with a mean of 1.46 PIs; 37.5% were full thickness. Admission Braden Scale for Pressure Sore Risk scores indicated that 77% were at risk for PI; subscores indicated mobility limitations in 90.8% and inadequate/poor nutrition in 41.3%. Subjects had multiple comorbid conditions (mean 18.4 ± 5.3 admission diagnoses). Only 21.4% were receiving home care services prior to admission. More than half (51.5%) were discharged to a healthcare facility, 33% to home, and 14% died or received hospice care. The 30-day readmission rate was 15.5%. CONCLUSION: The overall prevalence of POA-PIs on hospital admission in this study was higher than previous published reports. The majority arrived from community-dwelling locations. The severity of community-dwelling POA-PIs was higher than known benchmarked hospital-acquired PI severity. This real-world profile of community-dwelling patients with PI suggests that these individuals are considerably vulnerable and underserved by home care services. Opportunities exist for community PI screening, prevention, and intervention.

Cardiovascular health in adults with type 1 diabetes.

Adults with type 1 diabetes (T1D) are at risk for cardiovascular (CV) disease. Managing CV risk is an important prevention strategy. The American Heart Association has defined 7 factors for ideal CV health. The purpose of this 2016 secondary analysis was to assess the prevalence of 6 CV health factors in a sample of adults ≥18 (n=7153) in the T1D Exchange Clinic registry. CV health factors include: hemoglobin A1c (HbA1c) <7%, BMI<25kg/m2, blood pressure<120/80mmHg, total cholesterol <200mg/dL, non-smoking, and physical activity ≥150min/week. HbA1c<7% was substituted for the AHA health factor of fasting blood glucose. Frequencies of each factor were tabulated for the total sample and for each gender. Logistic regression examined variables associated with achievement of each CV health factor. The mean age was 37.14±17years. Mean HbA1c was 7.9±1.5%, and duration was 19.5±13.5years. The majority (54%) were working full or part-time. Achievement of CV health factors in the whole sample ranged from 27% (HbA1c<7%) to 94% nonsmoking. Achievement of some factors varied by gender. Common variables associated with several CV health factors included gender, education, employment, and T1D duration. This young sample exhibited low levels of some CV health factors, especially HbA1c and physical activity. Providers need to routinely assess and advise on management of all CV risk factors to prevent this common diabetes complication.

The Relationship Between Nurse Staffing and 30-Day Readmission for Adults With Heart Failure.

OBJECTIVE: The purpose of this study was to better understand the relationship between nurse staffing and 30-day excess readmission ratios for patients with heart failure in the top US adult cardiology and heart surgery hospitals. BACKGROUND: Heart failure is the most common cause of hospitalization for patients older than 65 years and is the most frequent diagnosis associated with 30-day hospital readmission in the United States. METHODS: A secondary data analysis was conducted using nurse staffing data from 661 cardiology and heart surgery hospitals from the 2013 US News & World Report "Best Hospitals" survey. These data were combined with excess readmission ratios from the Centers for Medicare & Medicaid Services Hospital Compare database from 2013. An independent-samples t test was used to compare staffing (low/high) and excess hospital readmissions rates. RESULTS: A significant difference (P = .021) was found between the low nurse staffing group (n = 358) and the high nurse staffing group (n = 303). Hospitals with a lower nurse staffing index had a significantly higher excess readmission rate. CONCLUSION: These data provide further support to the body of research showing a positive relationship between nurse staffing and positive outcomes.

Research: Use of Monitor Watchers in Hospitals: Characteristics, Training, and Practices.

Monitor watchers, or personnel whose job it is to watch the central cardiac monitor and alert clinicians of patient events, are used in many hospitals. Monitor watchers may be used to improve timely response to alarms and combat the effects of alarm fatigue. However, little research has been done on the use of monitor watchers, and their practices have not been well described. Therefore, the purpose of our study was to examine the use of monitor watchers and their characteristics, training, and practices. Participants were recruited to complete an online survey on monitor watcher practice via two professional nursing organizations. A total of 413 responded to the survey, including 411 nurses and two non-nurse professionals, and 61% reported that their hospital used monitor watchers. Of these, 60% indicated that their hospitals have been using monitor watchers for more than 10 years, and 62% said that the monitor watchers were located remotely from the patient care unit. Many (68%) reported that monitor watchers worked 12-hour shifts, and a majority said that monitor watchers were required to have a certificate in electrocardiographic monitoring (67%) and be high school graduates (64%). Most (70%) respondents reported that monitor watchers alerted the nurse of an event via a mobile phone carried by the nurse. The results of this survey revealed that monitor watcher practices varied widely. Further research is needed to determine if the use of monitor watchers has an impact on patient outcomes.

Missed opportunities for recognition of ischemic stroke in the emergency department.

INTRODUCTION: Evidence suggests that a significant number of patients discharged from the hospital with a diagnosis of ischemic stroke are not identified as having a stroke on admission. Those presenting with "nontraditional" stroke symptoms may be less likely to be diagnosed correctly. We aimed to establish whether there was an association between symptom presentation and diagnostic accuracy and to identify the type and frequency of nontraditional symptoms that resulted in a missed diagnosis in the emergency department. METHODS: We reviewed the medical records of 189 patients discharged with a diagnosis of ischemic stroke from Yale-New Haven Hospital. We performed χ(2) analysis to determine whether an association existed between symptom presentation and diagnostic accuracy. Descriptive statistics allowed us to identify symptom type and frequency in patients with a missed diagnosis. RESULTS: A diagnosis of suspected stroke was missed in 15.3% of patients who presented to the emergency department. We found a strong association (P < 0.0001) between symptom presentation and diagnostic accuracy. Of the patients presenting with any "traditional" symptom, 4% were missed. Of those presenting with only nontraditional symptoms, 64% were missed (odds ratio, 43.4; 95% confidence interval, 15.0-125.4). Nontraditional symptoms included generalized weakness, altered mental status, altered gait, and dizziness. DISCUSSION: In order to facilitate appropriate management of patients with ischemic stroke, emergency nurses must be aware that symptom presentation is highly variable. Patients presenting with nontraditional symptoms may benefit from an immediate and comprehensive neurological evaluation.

A mixed-methods approach to understand university students' perceived impact of returning to class during COVID-19 on their mental and general health.

PURPOSE: This study investigated the prevalence and risk factors of mental and general health symptoms among university students attending in-person and online classes during COVID-19. We also explored their experiences returning to in-person classes and their views on the university's COVID-19-related policies. METHODS: In this sequential explanatory mixed-methods study (2020-2021), U.S. university student respondents (N = 1030; 603 women [58.5%], 907 [88.1%] aged 18-24 years) completed a quantitative, cross-sectional survey assessing their mental and general health symptoms experienced while taking classes during the COVID-19 pandemic. The survey link was distributed through social media and email invitations. Three separate follow-up focus groups (n = 27), consisting of an average of nine focus group respondents who had completed the quantitative survey per group, were conducted using a semi-structured interview guide. Focus group respondents provided qualitative responses on their experiences returning to class during COVID-19 and adhering to COVID-19-related policies. RESULTS: The prevalence of mental health symptoms among survey respondents were 57.6% (n = 593) for depression, 41.5% (n = 427) for anxiety, and 40.8% (n = 420) for stress. Over 90% of respondents reported perceptions of good general health. Female respondents and respondents identified as non-binary gender had an increased risk for mental health symptoms compared to male respondents. Respondents with preexisting medical conditions had an increased risk for worse general health. Themes identified through qualitative analysis included (1) attending class during COVID-19 is associated with unhealthy behaviors, and poor health, (2) perceived challenges of online learning and increased feelings of isolation, (3) demand for COVID-19 policy reform and greater transparency of COVID-19 statistics; (4) difficulties in adhering to COVID-19 policies; and (5) concerns about acquiring and transmitting COVID-19. CONCLUSIONS: Our findings indicate that university students attending classes during the pandemic are experiencing negative mental health impacts. Although students were aware of COVID-19-related policies, many found it challenging to comply. Broad acceptance of COVID-19 policies will require greater transparency and information sharing.

High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: results of the QT in Practice (QTIP) Study.

OBJECTIVE: To test the potential value of more frequent QT interval measurement in hospitalized patients. DESIGN: We performed a prospective, observational study. SETTING: All adult intensive care unit and progressive care unit beds of a university medical center. PATIENTS: All patients admitted to one of six critical care units over a 2-month period were included in analyses. INTERVENTIONS: All critical care beds (n = 154) were upgraded to a continuous QT monitoring system (Philips Healthcare). MEASUREMENTS AND MAIN RESULTS: QT data were extracted from the bedside monitors for offline analysis. A corrected QT interval >500 msecs was considered prolonged. Episodes of QT prolongation were manually over-read. Electrocardiogram data (67,648 hrs, mean 65 hrs/patient) were obtained. QT prolongation was present in 24%. There were 16 cardiac arrests, with one resulting from Torsade de Pointes (6%). Predictors of QT prolongation were female sex, QT-prolonging drugs, hypokalemia, hypocalcemia, hyperglycemia, high creatinine, history of stroke, and hypothyroidism. Patients with QT prolongation had longer hospitalization (276 hrs vs. 132 hrs, p < .0005) and had three times the odds for all-cause in-hospital mortality compared to patients without QT prolongation (odds ratio 2.99 95% confidence interval 1.1-8.1). CONCLUSIONS: We find QT prolongation to be common (24%), with Torsade de Pointes representing 6% of in-hospital cardiac arrests. Predictors of QT prolongation in the acutely ill population are similar to those previously identified in ambulatory populations. Acutely ill patients with QT prolongation have longer lengths of hospitalization and nearly three times the odds for mortality then those without QT prolongation.

Consequences of clinical situations that cause critical care nurses to experience moral distress.

Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants' responses used an inductive approach and a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families.

Sex-specific impact of diabetes on all-cause mortality among adults with acute myocardial infarction: An updated systematic review and meta-analysis, 1988-2021.

Background: The prevalence of diabetes and its impact on mortality after acute myocardial infarction (AMI) are well-established. Sex-specific analyses of the impact of diabetes on all-cause mortality after AMI have not been updated and comprehensively investigated. Objective: To conduct a systematic review and meta-analysis that examined sex-specific short-term, mid-term and long-term all-cause mortality associated with diabetes among AMI survivors (diabetes versus non-diabetes patients in men and women separately), using up-to-date data. Methods: We systematically searched Embase and MEDLINE for studies that were published from inception to November 14, 2021. Studies were included if (1) they studied post-AMI all-cause-mortality in patients with and without diabetes, (2) sex-specific all-cause mortality at short-term (in-hospital or within 90 days after discharge), mid-term (>90 days and within 5 years), and/or long-term (>5 years) were reported. From eligible studies, we used random effects meta-analyses models to estimate pooled unadjusted and adjusted sex-specific risk ratio (RR) of all-cause mortality at short-, mid-, and long-term follow-up for adults with diabetes compared with those without diabetes. Results: Of the 3647 unique studies identified, 20 studies met inclusion criteria. In the unadjusted analysis (Total N=673,985; women=34.2%; diabetes patients=19.6%), patients with diabetes were at a higher risk for all-cause mortality at short-term (men: RR, 2.06; women: RR, 1.83); and mid-term follow-up (men: RR, 1.69; women: RR, 1.52) compared with those without diabetes in both men and women. However, when adjusted RRs were used (Total N=7,144,921; women=40.0%; diabetes patients=28.4%), the associations between diabetes and all-cause mortality in both men and women were attenuated, but still significantly elevated for short-term (men: RR, 1.16; 95% CI, 1.12-1.20; women: RR, 1.29; 95% CI, 1.15-1.46), mid-term (men: RR, 1.39; 95% CI, 1.31-1.46; women: RR, 1.38; 95% CI, 1.20-1.58), and long-term mortality (men: RR, 1.58; 95% CI, 1.22-2.05; women: RR, 1.76; 95% CI, 1.25-2.47). In men, all-cause mortality risk associated with diabetes tended to increase with the duration of follow-up (p<0.0001). Conclusions: Diabetes has substantial and sustained effects on post-AMI all-cause mortality at short-term, mid-term and long-term follow-up, regardless of sex. Tailoring AMI treatment based on patients' diabetes status, duration of follow-up and sex may help narrow the gap in all-cause mortality between patients with diabetes and those without diabetes.

A Proposed Transitional Care Tool to Improve Medication Continuity After Release of Older Inmates.

Despite a growing aging population in the correctional system, older persons are often released from jail unprepared for the transition to the free world and unable to access necessary medications. This article proposes a discharge form (transitional care tool) that may improve the medical care provided to older inmates upon release from jail, especially regarding their compliance with prescribed medications. The authors developed their tool in a three-step process: (1) review concerns raised in pertinent correctional medical literature, (2) expert panel determination of the relative importance for each of the concerns, and (3) assessment of the tool's likely efficacy as viewed by a focus group familiar with transitions to the free world after incarceration. Further research is required to validate the tool in the field.

Monitor-Watcher Use, Nurses' Knowledge of Electrocardiographic Monitoring, and Arrhythmia Detection.

BACKGROUND: Electrocardiographic telemetry monitors are ubiquitous in hospitals. Dedicated monitor watchers, either on the unit or in a centralized location, are often responsible for observing telemetry monitors and responding to their alarms. The impact of use of monitor watchers is not known. OBJECTIVES: To evaluate the association of monitor-watcher use with (1) nurses' knowledge of electrocardiographic (ECG) monitoring and (2) accuracy of arrhythmia detection. METHODS: Baseline data from 37 non-intensive care unit cardiac patient care areas in 17 hospitals in the Practical Use of the Latest Standards for Electrocardiography trial were analyzed. Nurses' knowledge (n = 1136 nurses) was measured using a validated, 20-item online test. Accuracy of arrhythmia detection (n = 1189 patients) was assessed for 5 consecutive days by comparing arrhythmias stored in the monitor with nurses' documentation. Multiple regression was used to evaluate the association of use of monitor watchers with scores on the ECG-monitoring knowledge test. The association of monitor-watcher use with accuracy of arrhythmia detection was examined by χ2 analysis. RESULTS: Of the 37 units, 13 (35%) had monitor watchers. Use of monitor watchers was not independently associated with ECG-monitoring knowledge (P = .08). The presence of monitor watchers also was not significantly associated with the accuracy of arrhythmia detection (P = .94). CONCLUSION: Although the use of monitor watchers was not associated with diminished nurses' knowledge of ECG monitoring, it also was not associated with more accurate arrhythmia detection. If implementing a monitor-watcher program, critical safety points, such as ensuring closed-loop communication, must be considered.

Comparison of Point-of-Care Testing Methods and Laboratory Analysis for Assessing Urine Specific Gravity and pH of Children Undergoing Chemotherapy.

BACKGROUND: To reduce the risk of renal toxicity, urine specific gravity (SG) and pH (potential of hydrogen) parameters should be met before nephrotoxic chemotherapeutic agents are administered. The purpose of this study was to compare laboratory urine SG and pH values with those obtained with urine point-of-care (POC) testing methods commonly used when caring for children receiving nephrotoxic chemotherapeutic agents. METHOD: A method-comparison design was used to compare the values of three POC methods for SG (dipstick, automated dipstick reader, refractometer) and three pH (dipstick, automated dipstick reader, litmus paper) methods with laboratory analysis of 86 urine samples from 43 children hospitalized on a pediatric hematology oncology unit in a large academic medical center. The Bland-Altman method was used to calculate bias and precision between POC and laboratory values. RESULTS: Except for the SG refractometer, bias values from Bland-Altman graphs demonstrated poor agreement between POC and laboratory urine SG and pH results. The precision values between these methods indicated overestimation or underestimation of hydration or urine pH status. Compared with laboratory methods, 31% of POC visual reading of dipstick SG values were falsely low-putting the patient at risk of not receiving necessary hydration and subsequent nephrotoxicity. DISCUSSION: In conclusion, most POC urine testing methods for SG and pH are not accurate compared with laboratory analysis. Because laboratory analyses can take longer than POC methods to obtain results, clinicians need to collaborate with laboratory medicine to ensure that an expedited process is in place in order to prevent chemotherapy administration delays.

Newly diagnosed diabetes and outcomes after acute myocardial infarction in young adults.

OBJECTIVE: To examine prevalence and characteristics of newly diagnosed diabetes (NDD) in younger adults hospitalised with acute myocardial infarction (AMI) and investigate whether NDD is associated with health status and clinical outcomes over 12-month post-AMI. METHODS: In individuals (18-55 years) admitted with AMI, without established diabetes, we defined NDD as (1) baseline or 1-month HbA1c≥6.5%; (2) discharge diabetes diagnosis or (3) diabetes medication initiation within 1 month. We compared baseline characteristics of NDD, established diabetes and no diabetes, and their associations with baseline, 1-month and 12-month health status (angina-specific and non-disease specific), mortality and in-hospital complications. RESULTS: Among 3501 patients in Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study, 14.5% met NDD criteria. Among 508 patients with NDD, 35 (6.9%) received discharge diagnosis, 91 (17.9%) received discharge diabetes education and 14 (2.8%) initiated pharmacological treatment within 1 month. NDD was more common in non-White (OR 1.58, 95% CI 1.23 to 2.03), obese (OR 1.72, 95% CI 1.39 to 2.12), financially stressed patients (OR 1.27, 95% CI 1.02 to 1.58). Compared with established diabetes, NDD was independently associated with better disease-specific health status and quality of life (p≤0.04). No significant differences were found in unadjusted in-hospital mortality and complications between NDD and established or no diabetes. CONCLUSIONS: NDD was common among adults≤55 years admitted with AMI and was more frequent in non-White, obese, financially stressed individuals. Under 20% of patients with NDD received discharge diagnosis or initiated discharge diabetes education or pharmacological treatment within 1 month post-AMI. NDD was not associated with increased risk of worse short-term health status compared with risk noted for established diabetes. TRIAL REGISTRATION NUMBER: NCT00597922.