High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy.
<h4>Background</h4>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.<h4...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0212398 |
| _version_ | 1819142630399803392 |
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| author | Martina Ventura Valeria Belleudi Paolo Sciattella Riccardo Di Domenicantonio Mirko Di Martino Nera Agabiti Marina Davoli Danilo Fusco |
| author_facet | Martina Ventura Valeria Belleudi Paolo Sciattella Riccardo Di Domenicantonio Mirko Di Martino Nera Agabiti Marina Davoli Danilo Fusco |
| author_sort | Martina Ventura |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Aim</h4>The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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. |
| first_indexed | 2024-12-22T12:13:24Z |
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| id | doaj.art-2ea01e91ac2b4602be379c0d4279315d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T12:13:24Z |
| publishDate | 2019-01-01 |
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| spelling | doaj.art-2ea01e91ac2b4602be379c0d4279315d2022-12-21T18:26:13ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01142e021239810.1371/journal.pone.0212398High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy.Martina VenturaValeria BelleudiPaolo SciattellaRiccardo Di DomenicantonioMirko Di MartinoNera AgabitiMarina DavoliDanilo Fusco<h4>Background</h4>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.<h4>Aim</h4>The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0212398 |
| spellingShingle | Martina Ventura Valeria Belleudi Paolo Sciattella Riccardo Di Domenicantonio Mirko Di Martino Nera Agabiti Marina Davoli Danilo Fusco High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. PLoS ONE |
| title | High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. |
| title_full | High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. |
| title_fullStr | High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. |
| title_full_unstemmed | High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. |
| title_short | High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. |
| title_sort | high quality process of care increases one year survival after acute myocardial infarction ami a cohort study in italy |
| url | https://doi.org/10.1371/journal.pone.0212398 |
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