急性心肌梗死（AMI）后的管理式医疗（MC-AMI）改善了伴有心力衰竭的 AMI 幸存者的预后：波兰全面心梗后护理国家计划的倾向性评分匹配分析。

Managed Care after Acute Myocardial Infarction (MC-AMI) improves prognosis in AMI survivors with pre-existing heart failure: A propensity score matching analysis of Polish nationwide program of comprehensive post-MI care.

机构信息

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.

出版信息

Kardiol Pol. 2022;80(3):293-301. doi: 10.33963/KP.a2022.0029. Epub 2022 Feb 3.

DOI:10.33963/KP.a2022.0029

Abstract

BACKGROUND

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.

AIMS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

目的

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。

结果

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）。