Innovative Managed Care May Be Related to Improved Prognosis for Acute Myocardial Infarction Survivors.

Autor:	Jankowski P; I Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (P.J.)., Topór-Mądry R; Agency for Health Technology Assessment and Tariff System, Warsaw, Poland (R.T.-M., U.C.)., Gąsior M; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze (M. Gąsior), Medical University of Silesia, Katowice, Poland., Cegłowska U; Agency for Health Technology Assessment and Tariff System, Warsaw, Poland (R.T.-M., U.C.)., Eysymontt Z; Cardiac Rehabilitation Department, Ślaskie Centrum Rehabilitacji w Ustroniu, Ustron, Poland (Z.E.)., Gierlotka M; Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland (M. Gierlotka)., Wita K; First Department of Cardiology, School of Medicine in Katowice (K.W.), Medical University of Silesia, Katowice, Poland., Legutko J; Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland (J.L.)., Dudek D; Institute of Cardiology, Jagiellonian University, Kopernika 17, Krakow, Poland (D.D.)., Sierpiński R; Medical Research Agency, Warsaw, Poland (R.S.)., Pinkas J; School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland (J.P.)., Kaźmierczak J; Department of Cardiology, Pomeranian Medical University, Szczecin, Poland (J.K.)., Witkowski A; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (A.W.)., Szumowski Ł; National Institute of Cardiology in Warsaw, Poland (L.S.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2021 Aug; Vol. 14 (8), pp. e007800. Date of Electronic Publication: 2021 Aug 12.
DOI:	10.1161/CIRCOUTCOMES.120.007800
Abstrakt:	Background: Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland. Methods: We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged <18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death from any cause. Results: The mean follow-up was 324.8±140.5 days (78 034.1 patient-years; 340.0±131.7 days in those who did not die during the observation). Participation in the managed care program was related to higher odds ratio of participating in cardiac rehabilitation (4.67 [95% CI, 4.44-4.88]), consultation with a cardiologist (7.32 [6.83-7.84]), implantable cardioverter-defibrillator (1.40 [1.22-1.61]), and cardiac resynchronization therapy with cardioverter-defibrillator implantation (1.57 [1.22-2.03]) but lower odds of emergency (0.88 [0.79-0.98]) and nonemergency percutaneous coronary intervention (0.88 [0.83-0.93]) and coronary artery bypass grafting (0.82 [0.71-0.94]) during the follow-up. One-year all-cause mortality was 4.4% among the program participants and 6.0% in matched nonparticipants. The end point consisting of all-cause death, myocardial infarction, or stroke occurred in 10.6% and 12.0% ( P <0.01) of participants and nonparticipants respectively, whereas all-cause death or hospitalization for cardiovascular reasons in 42.2% and 47.9% ( P <0.001) among participants and nonparticipants, respectively. The difference in outcomes between patients participating and not participating in the managed care program could be explained by improved access to cardiac rehabilitation, cardiac care, and cardiac procedures. Conclusions: Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu