Managed Care after Acute Myocardial Infarction (KOS-zawał) reduces major adverse cardiovascular events by 45% in 3-month follow-up - single-center results of Poland's National Health Fund program of comprehensive post-myocardial infarction care

Krystian Wita; Andrzej Kułach; Marcin Wita; Maciej T Wybraniec; Katarzyna Wilkosz; Mateusz Polak; Monika Matla; Łukasz Maciejewski; Joanna Fluder; Barbara Kalańska-Łukasik; Tomasz Skowerski; Szymon Gomułka; Krzysztof Szydło

doi:10.5114/aoms.2019.85649

Managed Care after Acute Myocardial Infarction (KOS-zawał) reduces major adverse cardiovascular events by 45% in 3-month follow-up - single-center results of Poland's National Health Fund program of comprehensive post-myocardial infarction care

Arch Med Sci. 2019 Jun 6;16(3):551-558. doi: 10.5114/aoms.2019.85649. eCollection 2020.

Affiliations

¹ First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
² Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
³ Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
⁴ Daily Cardiology Rehabilitation Department, Upper Silesian Medical Center in Katowice, Katowice, Poland.

Abstract

Introduction: Despite progress in medical and interventional treatment of acute myocardial infarction (AMI) resulting in low in-hospital mortality, the post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawał) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), scheduled outpatient follow-up, and prevention of sudden cardiac death. The aim of the study was to assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in 3-month follow-up.

Material and methods: In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1 : 1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE.

Results: MC-AMI participation is related to reduced MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR = 0.476, 95% CI: 0.283-0.799, p < 0.005). Also, older age, male sex (HR = 2.0), history of unstable angina (HR = 3.15), peripheral artery disease (HR = 2.17), peri-MI atrial fibrillation (HR = 1.87) and diabetes (HR = 1.5) were significantly associated with MACE.

Conclusions: Participation in MC-AMI - the first comprehensive in-hospital and post-discharge care for AMI patients - improves prognosis and is related to a MACE rate reduction by 45% as soon as in 3 months.

Keywords: Managed Care in Acute Myocardial Infarction; cardiac rehabilitation; cardiovascular prevention; major adverse cardiovascular events; myocardial infarction.