High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy.
Adrenergic beta-Antagonists
/ therapeutic use
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors
/ therapeutic use
Female
Guideline Adherence
/ statistics & numerical data
Hospitalization
/ statistics & numerical data
Humans
Male
Myocardial Infarction
/ mortality
Patient Discharge
/ statistics & numerical data
Percutaneous Coronary Intervention
/ mortality
Prognosis
Quality of Health Care
Retrospective Studies
Survival Rate
Travel
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
11
06
2018
accepted:
03
02
2019
entrez:
21
2
2019
pubmed:
21
2
2019
medline:
26
11
2019
Statut:
epublish
Résumé
The relationship between guideline adherence and outcomes in patients with acute myocardial infarction (AMI) has been widely investigated considering the emergency, acute, post-acute phases separately, but the effectiveness of the whole care process is not known. The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI. We conducted a cohort study selecting all incident cases of AMI from health information systems during 2011-2014 in the Lazio region. Patients' clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. For each subject the probability to reach the hospital and the conditional probabilities to survive to 30 days from admission and to 31-365 days post discharge were estimated through multivariate logistic models. The 1-year survival probability was calculated as the product of the three probabilities. Quality of care indicators were identified in terms of emergency timeliness (time between residence and the nearest hospital), hospital performance in treatment of acute phase (number/timeliness of PCI on STEMI) and drug therapy in post-acute phase (number of drugs among antiplatelet, β-blockers, ACE inhibitors/ARBs, statins). The 1-year survival Probability Ratio (PR) and its Bootstrap Confidence Intervals (BCI) between who were exposed to the highest level of quality of care (timeliness<10', hospitalization in high performance hospital, complete drug therapy) and who exposed to the worst (timeliness≥10', hospitalization in low performance hospital, suboptimal drug therapy) were calculated for a mean-severity patient and varying gender and age. PRs for patients with diabetes and COPD were also evaluated. We identified 38,517 incident cases of AMI. The out-of-hospital mortality was 27.6%. Among the people arrived in hospital, 42.9% had a hospitalization for STEMI with 11.1% of mortality in acute phase and 5.4% in post-acute phase. For a mean-severity patient the PR was 1.19 (BCI 1.14-1.24). The ratio did not change by gender, while it moved from 1.06 (BCI 1.05-1.08) for age<65 years to 1.62 (BCI 1.45-1.80) for age >85 years. For patients with diabetes and COPD a slight increase in PRs was also observed. The 1-year survival probability post AMI depends strongly on the quality of the whole multicomponent continuum of care. Improving the performance in the different phases, taking into account the relationship among these, can lead to considerable saving of lives, in particular for the elderly and for subjects with chronic diseases.
Sections du résumé
BACKGROUND
The relationship between guideline adherence and outcomes in patients with acute myocardial infarction (AMI) has been widely investigated considering the emergency, acute, post-acute phases separately, but the effectiveness of the whole care process is not known.
AIM
The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI.
METHODS
We conducted a cohort study selecting all incident cases of AMI from health information systems during 2011-2014 in the Lazio region. Patients' clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. For each subject the probability to reach the hospital and the conditional probabilities to survive to 30 days from admission and to 31-365 days post discharge were estimated through multivariate logistic models. The 1-year survival probability was calculated as the product of the three probabilities. Quality of care indicators were identified in terms of emergency timeliness (time between residence and the nearest hospital), hospital performance in treatment of acute phase (number/timeliness of PCI on STEMI) and drug therapy in post-acute phase (number of drugs among antiplatelet, β-blockers, ACE inhibitors/ARBs, statins). The 1-year survival Probability Ratio (PR) and its Bootstrap Confidence Intervals (BCI) between who were exposed to the highest level of quality of care (timeliness<10', hospitalization in high performance hospital, complete drug therapy) and who exposed to the worst (timeliness≥10', hospitalization in low performance hospital, suboptimal drug therapy) were calculated for a mean-severity patient and varying gender and age. PRs for patients with diabetes and COPD were also evaluated.
RESULTS
We identified 38,517 incident cases of AMI. The out-of-hospital mortality was 27.6%. Among the people arrived in hospital, 42.9% had a hospitalization for STEMI with 11.1% of mortality in acute phase and 5.4% in post-acute phase. For a mean-severity patient the PR was 1.19 (BCI 1.14-1.24). The ratio did not change by gender, while it moved from 1.06 (BCI 1.05-1.08) for age<65 years to 1.62 (BCI 1.45-1.80) for age >85 years. For patients with diabetes and COPD a slight increase in PRs was also observed.
CONCLUSIONS
The 1-year survival probability post AMI depends strongly on the quality of the whole multicomponent continuum of care. Improving the performance in the different phases, taking into account the relationship among these, can lead to considerable saving of lives, in particular for the elderly and for subjects with chronic diseases.
Identifiants
pubmed: 30785928
doi: 10.1371/journal.pone.0212398
pii: PONE-D-18-17203
pmc: PMC6382131
doi:
Substances chimiques
Adrenergic beta-Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0212398Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Eur J Epidemiol. 2007;22(3):145-9
pubmed: 17356927
Am J Cardiol. 2004 Jul 1;94(1):25-9
pubmed: 15219503
Heart. 2008 Sep;94(9):1141-6
pubmed: 17984217
Am Heart J. 2010 Jun;159(6):1012-9
pubmed: 20569714
Eur Heart J Suppl. 2017 May;19(Suppl D):D130-D150
pubmed: 28751840
Circulation. 2004 Feb 17;109(6):745-9
pubmed: 14970110
J Intern Med. 1997 Jun;241(6):485-92
pubmed: 10497624
J Am Coll Cardiol. 1996 Jun;27(7):1646-55
pubmed: 8636549
BMJ. 2009 Jan 26;338:b36
pubmed: 19171564
Pharmacoepidemiol Drug Saf. 2011 Feb;20(2):169-76
pubmed: 21254288
Eur Heart J Acute Cardiovasc Care. 2017 Apr;6(3):254-261
pubmed: 26888787
Am J Cardiol. 2009 Nov 1;104(9):1198-203
pubmed: 19840562
J Korean Med Sci. 2013 Dec;28(12):1749-55
pubmed: 24339704
Int J Cardiol. 2016 Dec 1;224:72-78
pubmed: 27631718
Eur Heart J. 2018 Jan 7;39(2):119-177
pubmed: 28886621
Pharmacoepidemiol Drug Saf. 2013 Jun;22(6):649-57
pubmed: 23529919
Circulation. 2011 Nov 29;124(22):2458-73
pubmed: 22052934
BMJ. 2014 Jan 21;348:f7393
pubmed: 24452368
J Am Coll Cardiol. 2006 Jun 6;47(11):2180-6
pubmed: 16750682
Am Heart J. 2007 Dec;154(6):1108-15
pubmed: 18035083
BMJ Open. 2018 May 3;8(5):e020211
pubmed: 29724738
JAMA. 2000 Jun 14;283(22):2941-7
pubmed: 10865271
BMJ. 2007 May 19;334(7602):1044
pubmed: 17452389
Chest. 2012 Jun;141(6):1441-1448
pubmed: 22207679
Eur J Prev Cardiol. 2016 Dec;23(18):1994-2006
pubmed: 27600690
Diabetes Care. 1991 Jul;14(7):537-43
pubmed: 1914792
JAMA. 2005 Aug 17;294(7):803-12
pubmed: 16106005
J Am Coll Cardiol. 2013 Jan 29;61(4):485-510
pubmed: 23256913
JAMA. 2002 Mar 13;287(10):1269-76
pubmed: 11886318
Am J Cardiol. 2003 Jun 15;91(12):1401-5
pubmed: 12804723
Eur J Epidemiol. 2007;22(12):883-8
pubmed: 17926133
BMC Health Serv Res. 2012 Jan 27;12:25
pubmed: 22283880
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):82-92
pubmed: 20123674
BMC Public Health. 2016 May 16;16:408
pubmed: 27184959
Circulation. 2004 Mar 16;109(10):1223-5
pubmed: 15007008
Circ Cardiovasc Qual Outcomes. 2015 Nov;8(6):608-20
pubmed: 26555125
J Am Coll Cardiol. 2003 Sep 17;42(6):991-7
pubmed: 13678918
Lancet. 2008 Aug 16;372(9638):570-84
pubmed: 18707987
World J Cardiol. 2014 Jun 26;6(6):424-33
pubmed: 24976914
Am J Cardiol. 2014 Aug 1;114(3):329-35
pubmed: 24927969
Korean Circ J. 2009 Jun;39(6):243-50
pubmed: 19949630
Eur Heart J. 2004 Jun;25(11):926-31
pubmed: 15172464
Nurs Midwifery Stud. 2014 Dec;3(4):e24238
pubmed: 25741517
COPD. 2012 Apr;9(2):184-96
pubmed: 22409483
JAMA. 2010 Aug 18;304(7):763-71
pubmed: 20716739
Ann Intern Med. 1997 Oct 15;127(8 Pt 2):666-74
pubmed: 9382378
BMJ Open. 2015 Sep 11;5(9):e007824
pubmed: 26362660
Int J Qual Health Care. 2014 Jun;26(3):223-30
pubmed: 24737832
Heart. 2015 Jul;101(14):1103-10
pubmed: 25765553
JACC Cardiovasc Interv. 2011 Jun;4(6):599-604
pubmed: 21700244
N Engl J Med. 2013 Sep 5;369(10):889-92
pubmed: 24004114
PLoS One. 2015 Sep 09;10(9):e0137047
pubmed: 26352574
Open Heart. 2014 Dec 13;1(1):e000051
pubmed: 25525504
BMC Cardiovasc Disord. 2017 Feb 7;17(1):54
pubmed: 28173757
PLoS One. 2016 Jun 23;11(6):e0158336
pubmed: 27336859
Am J Cardiol. 2010 May 1;105(9):1229-34
pubmed: 20403471
Epidemiol Prev. 2012 May-Aug;36(3-4):162-71
pubmed: 22828229
BMJ Open. 2016 Apr 04;6(4):e010926
pubmed: 27044584
Am J Cardiol. 2017 May 15;119(10):1555-1559
pubmed: 28390680
Eur J Clin Pharmacol. 2015 Feb;71(2):243-50
pubmed: 25529226
Circ Cardiovasc Qual Outcomes. 2014 Jan;7(1):86-94
pubmed: 24425697
Clin Res Cardiol. 2014 Aug;103(8):655-64
pubmed: 24604524