3rd Department of Cardiology, Silesian Center for Heart Disease, Zabrze, Poland.
3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Kardiol Pol. 2022;80(3):293-301. doi: 10.33963/KP.a2022.0029. Epub 2022 Feb 3.
Despite improvement in acute myocardial infarction (AMI) treatment, post-discharge mortality remains high. The outcomes are supposed to be even worse in patients with post-MI heart failure (HF), as only a half of patients with newly diagnosed HF survive four years.
The study aimed to analyze whether managed care after acute myocardial infarction (MC-AMI) is associated with better survival in AMI survivors with a pre-existing diagnosis of HF.
The study included 7228 patients with a pre-existing diagnosis of HF who survived the hospitalization for AMI in Poland between November 2017 and December 2020, of whom 2268 (31.4%) were referred for the MC-AMI program. The median follow-up was 1.5 (0.7-2.3) years. In the unmatched analysis, patients without MC-AMI had more than twice higher 12-month mortality (21.8% vs. 9.9%; P <0.01) than MC-AMI participants. The difference remained significant after propensity score matching (16,8% vs. 10.0%; P <0.01). In multivariable analysis, participation in MC-AMI was an independent factor of 12-month survival. MC-AMI participants had a lower stroke rate (1.5% vs. 3.0%; P <0.01) and fewer hospital admissions due to HF (22.9% vs. 27.6%; P <0.01).
After propensity score matching, participation in MC-AMI was associated with lower rates of stroke, HF hospitalizations, and all-cause mortality in the 12-month follow-up and was an independent factor of 12-month survival in AMI survivors with pre-existing HF.
尽管急性心肌梗死（AMI）的治疗有所改善，但出院后的死亡率仍然很高。在患有心肌梗死后心力衰竭（HF）的患者中，情况应该更糟，因为只有一半新诊断为 HF 的患者能在四年内存活。
本研究旨在分析急性心肌梗死后管理式医疗（MC-AMI）是否与存在 HF 的 AMI 幸存者的生存改善相关。
该研究纳入了 7228 名在波兰于 2017 年 11 月至 2020 年 12 月期间因 AMI 住院存活且存在 HF 既往诊断的患者，其中 2268 名（31.4%）被转介至 MC-AMI 项目。中位随访时间为 1.5（0.7-2.3）年。在未匹配分析中，未接受 MC-AMI 的患者 12 个月死亡率（21.8%比 9.9%；P<0.01）高于 MC-AMI 参与者。在倾向评分匹配后，差异仍然显著（16.8%比 10.0%；P<0.01）。多变量分析显示，参与 MC-AMI 是 12 个月生存的独立因素。MC-AMI 参与者的卒中发生率较低（1.5%比 3.0%；P<0.01），HF 住院率较低（22.9%比 27.6%；P<0.01）。
在倾向评分匹配后，参与 MC-AMI 与 12 个月随访期间的卒中、HF 住院和全因死亡率降低相关，并且是存在 HF 的 AMI 幸存者 12 个月生存的独立因素。
