Managed Care after Acute Myocardial Infarction (MC-AMI) — Poland’s nationwide program of comprehensive post-MI care improves prognosis in 2-year follow-up. A single high-volume center intention-to-treat analysis

Abstract

Background: Managed Care in Acute Myocardial Infarction (MC-AMI) is a program introduced in Poland aimed at comprehensive, scheduled, and supervised care for AMI patients to improve longterm prognosis.Aims: Our study aimed to compare 24-month mortality and the incidence of major cardiovascular events (MACE: a composite of death, recurrent MI, and hospitalization for heart failure) in a cohort of AMI patients treated in the MC-AMI era (intention-to-treat analysis) vs. similar population treated before the MC-AMI era. Methods:We analyzed 2323 consecutive patients with AMI: 1261 patients enrolled in the MC-AMI era (study group) and 1062 patients treated 12 months before the MC-AMI era (control group). In the study group, 57% of patients participated in MC-AMI while 43% of patients remained under standard care. The patients were followed up for 24 months. Mortality and MACE were recorded.Results: Treatment in the MC-AMI era was related to a 30% reduction in all-cause mortality and a 14% reduction of MACE although it was not related to the reduction of hospitalization for heart failure (HF) or AMI in 24 months. The 24-month survival rate was the highest in MC-AMI enrolled patients while patients treated in the MC-AMI era but not enrolled had a similar prognosis to those treated before the MC-AMI era. Multivariable Cox regression analysis revealed the MC-AMI era to be inversely associated with mortality in 24-month follow-up (hazard ratio [HR], 0.49; 95% confidence interval [Cl], 0.38-0.65; P <0.001).Conclusions: AMI treatment in the MC-AMI era reduces 24-month mortality and MACE. Moreover, AMI treatment in MC-AMI is inversely related to mortality, MACE, and hospitalization for HF. The effect is pronounced in patients enrolled in MC-AMI.

A novel approach to post-acute myocardial infarction care

“…It is also worth mentioning that in this study [14] AMI was not diagnosed using the latest universal definition of MI. In addition, the dataset is missing some variables, including socioeconomic and behavioral risk factors, which could potentially affect both enrollment and compliance.…”

“…Notably, differences were seen as soon as 3 months following intervention. In this current publication, Kułach et al [14] compared the 24-month mortality rates and incidence of major adverse cardiovascular events (MACE: a composite of death, recurrent MI, and hospitalization for heart failure) in a cohort of AMI patients treated in the MC-AMI era (intention-to-treat analysis) vs. similar population treated before the MC-AMI era. The investigators analyzed 2323 consecutive patients with AMI: 1261 patients enrolled in the MC-AMI era (study group) and 1062 patients treated 12 months before the MC-AMI era (control).…”

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

“…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.…”

“…Revascularisation procedures are carried out in cardiac catheter laboratories that provide 24 h haemodynamic emergency services. In Poland, there is a network of 160 interventional cardiology centres, performing 735 percutaneous coronary interventions per million inhabitants [5,6]. These advanced methods of diagnosis and treatment have resulted in a significant reduction in early adverse events, including in-hospital deaths in the acute phase of myocardial infarction [7].…”

Assessment of qualitative body composition, including phase angle, in the context of primary prevention and secondary prevention of cardiovascular diseases (cardiac 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].…”