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

Abstract

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.

Feasibility of hybrid telerehabilitation as a component of Managed Care after Acute Myocardial Infarction (MC-AMI) in a 12-month follow-up: experience from a single center

“…The 1-year all-cause mortality was significantly statistically lower in study group when compared with patient without MC-AMI. These data confirmed the results obtained in other centers that run or analyzed the MC-AMI program [26,27,28,29,30]. In the two largest nation-wide analyses of effectivness of MC-AMI, participating in the program was related with improved prognosis [26,27].…”

Clinical characteristics and 12-month outcomes in MINOCA patients before and during the COVID-19 pandemic

“…This might have been associated with worse diagnostic in Poland, mainly based on echocardiography and coronary angiography, and rarely enriched with intravascular imaging and cardiac magnetic resonance. Also, this might be related to poor long-term monitoring of patients with acute coronary syndrome [25], and as was shown, patients with proper follow-up characterized better outcomes in Poland [26]. In our study, the 12-month outcomes showed a trend to be worse for MINOCA patients in 2020, with male sex (HR 2.09, 95% CI 1.43-3.05), age (HR 1.07, 95% CI 1.05-1.09), chronic kidney disease (HR 2.07, 95% CI 1.27-3.38), peripheral artery disease (HR 1.96, 95% CI 1.10 -3.47), and STEMI at admission (HR 2.10, 95% CI 1.17-3.79) as the poorest prognostic factors.…”

The burden of cardiovascular disease risk factors: A current problem

“…In patients covered by the new system, the rate of participation in outpatient cardiac rehabilitation was six times greater than in patients who were not. A smaller but notifiable evident was recorded for the participation rate in the inpatient cardiac rehabilitation that was higher by about 53% [58]. Earlier experience from an experimental study carried out in Polish CHD and high-risk patients suggested that a managed, comprehensive cardiac prevention and rehabilitation program is an effective lifesaving procedure [59].…”

“…Earlier experience from an experimental study carried out in Polish CHD and high-risk patients suggested that a managed, comprehensive cardiac prevention and rehabilitation program is an effective lifesaving procedure [59]. Analysis of the new system of managed care confirm that improved access to cardiac rehabilitation, along with improved access to cardiac consultations and invasive treatment procedures, might contribute to the 30% lower risk of death, observed within 1 year after hospitalization in patients participating in the new system compared to those who are not [58]. However, no information is available on how much of the effect on mortality could be attributed to the reduction of risk factors.…”