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Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis

Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland’s National Health Fund that aims at compre...

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Autores principales: Wita, Krystian, Kułach, Andrzej, Sikora, Jacek, Fluder, Joanna, Nowalany-Kozielska, Ewa, Milewski, Krzysztof, Pączek, Piotr, Sobocik, Henryk, Olender, Jacek, Szela, Lucjan, Kalarus, Zbigniew, Buszman, Pawel, Jankowski, Piotr, Gąsior, Mariusz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600386/
https://www.ncbi.nlm.nih.gov/pubmed/33008030
http://dx.doi.org/10.3390/jcm9103178
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author Wita, Krystian
Kułach, Andrzej
Sikora, Jacek
Fluder, Joanna
Nowalany-Kozielska, Ewa
Milewski, Krzysztof
Pączek, Piotr
Sobocik, Henryk
Olender, Jacek
Szela, Lucjan
Kalarus, Zbigniew
Buszman, Pawel
Jankowski, Piotr
Gąsior, Mariusz
author_facet Wita, Krystian
Kułach, Andrzej
Sikora, Jacek
Fluder, Joanna
Nowalany-Kozielska, Ewa
Milewski, Krzysztof
Pączek, Piotr
Sobocik, Henryk
Olender, Jacek
Szela, Lucjan
Kalarus, Zbigniew
Buszman, Pawel
Jankowski, Piotr
Gąsior, Mariusz
author_sort Wita, Krystian
collection PubMed
description Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland’s National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up. Methods: MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression. Results: MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42–0.65, p < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction. Conclusions: Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed.
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spelling pubmed-76003862020-11-01 Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis Wita, Krystian Kułach, Andrzej Sikora, Jacek Fluder, Joanna Nowalany-Kozielska, Ewa Milewski, Krzysztof Pączek, Piotr Sobocik, Henryk Olender, Jacek Szela, Lucjan Kalarus, Zbigniew Buszman, Pawel Jankowski, Piotr Gąsior, Mariusz J Clin Med Article Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland’s National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up. Methods: MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression. Results: MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42–0.65, p < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction. Conclusions: Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed. MDPI 2020-09-30 /pmc/articles/PMC7600386/ /pubmed/33008030 http://dx.doi.org/10.3390/jcm9103178 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wita, Krystian
Kułach, Andrzej
Sikora, Jacek
Fluder, Joanna
Nowalany-Kozielska, Ewa
Milewski, Krzysztof
Pączek, Piotr
Sobocik, Henryk
Olender, Jacek
Szela, Lucjan
Kalarus, Zbigniew
Buszman, Pawel
Jankowski, Piotr
Gąsior, Mariusz
Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis
title Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis
title_full Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis
title_fullStr Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis
title_full_unstemmed Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis
title_short Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis
title_sort managed care after acute myocardial infarction (mc-ami) reduces total mortality in 12-month follow-up—results from a poland’s national health fund program of comprehensive post-mi care—a population-wide analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600386/
https://www.ncbi.nlm.nih.gov/pubmed/33008030
http://dx.doi.org/10.3390/jcm9103178
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