Does gender affect the outcomes of patients in program of managed care for acute myocardial infarction

Abstract

Background There is increasing evidence that cardiac rehabilitation and regular follow-ups are associated with reduced mortality and morbidity. A programme of Managed Care for Patients with Acute Myocardial Infarction was developed in Poland (MC-AMI; in Polish, KOS-zawał), based on current scientific evidence. However, there is a lack of data on possible improvement in long-term prognosis among women after acute myocardial infarction. Aims To compare the male and female population who participated in MC-AMI, regarding major cardiovascular events, defined as a composite of death, recurrent myocardial infarction, and hospitalization for heart failure, in a 1-year follow-up. Methods A prospective research study from a single cardiology care centre. The study compared 2 groups: women and men who agreed to participate in the MC-AMI programme. Results A total of 529 patients were included in the study (167 women and 362 men). In the 12-month follow-up, the difference in major cardiovascular events events was not statistically significant for women and men, respectively (11.38% women vs 11.33% men; p = 0.98). Cox multivariate regression analysis of the surveyed population showed that coronary heart disease, diabetes mellitus type II, and previous percutaneous coronary intervention were significantly correlated with the primary endpoint. Conclusion Women participating in the MC-AMI programme did not have a worse prognosis regarding major cardiovascular events, compared with men in a 12-month follow-up. Given the benefits of the MCAMI programme, the proportion of women participating in the programme should be increased. LAY ABSTRACT Despite the development of new treatment techniques, myocardial infarction remains one of the leading causes of death in Europe. Women account for 48% of patients with myocardial infarction. Due to clinical, economic, demographic and sociological conditions, the long-term prognosis for women after myocardial infarction is worse than for men. A national programme of managed care after myocardial infarction has been introduced in 2019 year in Poland (MC-AMI; in Polish, KOS-zawał). The programme comprises 4 stages: hospitalization and treatment of the acute phase of myocardial infarction; early cardiological rehabilitation; regular follow-up at in-patient clinic; and evaluation of indications for advanced methods of treatment of post-infarction complications. Implementation of this programme in Poland has resulted in a comparable long-term prognosis being achieved for the male and female population. Widespread use of the MC-AMI programme is a promising option to equalize the prognosis for both sexes after a heart attack.

Evaluation of Change in Body Composition, including Phase Angle, in Post-Myocardial Infarction Patients Rehabilitated under the KOS-Zawał (MC-AMI) Programme

“…Despite the well-known benefits of cardiac rehabilitation, there is still a lack of sufficient methods to motivate patients to participate in this form of therapy, especially for the female group [11,15].…”

“…Cardiac rehabilitation is carried out by an interdisciplinary team enabling a holistic approach to the patient, and, consequently, dietary and psychological education is also present. The MC-AMI programme, which has been in operation for more than six years continuously, has undeniable clinical and economic benefits, which have been confirmed by numerous research studies showing short-term benefits as well as those from longer-term (12-month, 24-month) follow-up [4,6,9,[14][15][16][17][18][19]. Those studies focused on a range of variables that affect observed outcomes, which, in turn, become drivers to further improve the system and introduce tools to further motivate patients.…”

Assessment of qualitative body composition, including phase angle, in the context of primary prevention and secondary prevention of cardiovascular diseases (cardiac rehabilitation)

“…It is worrying that cardiac rehabilitation after myocardial infarction is used by far fewer women than men (socio-economic reasons); hence, the long-term prognosis of women after myocardial infarction is worse than that of men. In a study by Wilkosz et al [22], there were no significant differences in major adverse cardiac and cerebrovascular event (MACCE) rates between the 2 sexes at a 12-month follow-up of patients in MC-AMI. This shows that women need to be encouraged to participate in MC-AMI and that rehabilitation programmes must be tailored to women's needs (e.g., through online rehabilitation and hybrid rehabilitation).…”

“…Furthermore, dietary and psychological education is provided. The programme has continued to the present day with studies showing its significant clinical benefits [7,[21][22][23][24][25][26][27][28].…”

Value-based medicine as an opportunity for the Polish health care system in a post-pandemic reality on the example of selected health programs

“…An example of the implementation of value-based medicine is the comprehensive program of coordinated care after myocardial infarction (KOS-Zawał) or otherwise the Managed Care in Acute Myocardial Infarction (MC-AMI) (Wita et al, 2019a, 551;2019b, 8). MC-AMI is the Polish Cardiac Society, National Health Fund, and Ministry of Health program implemented in the fourth quarter of 2017 to improve hospital and post-discharge care in acute myocardial infarction patients (Gąsior et al, 2022, 303;Wilkosz et al, 2021). This program arose because of Poland's high morbidity and mortality from cardiovascular diseases.…”