Cargando…
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...
Autores principales: | , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783603131628650496 |
---|---|
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. |
format | Online Article Text |
id | pubmed-7600386 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT witakrystian managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT kułachandrzej managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT sikorajacek managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT fluderjoanna managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT nowalanykozielskaewa managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT milewskikrzysztof managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT paczekpiotr managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT sobocikhenryk managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT olenderjacek managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT szelalucjan managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT kalaruszbigniew managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT buszmanpawel managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT jankowskipiotr managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis AT gasiormariusz managedcareafteracutemyocardialinfarctionmcamireducestotalmortalityin12monthfollowupresultsfromapolandsnationalhealthfundprogramofcomprehensivepostmicareapopulationwideanalysis |