• Arch Med Sci · Jan 2020

    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, and Krzysztof Szydło.
    • First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
    • Arch Med Sci. 2020 Jan 1; 16 (3): 551-558.

    IntroductionDespite 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 MethodsIn 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.ResultsMC-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.ConclusionsParticipation 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.Copyright: © 2019 Termedia & Banach.

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