Long term outcomes of a coordinate care program in patients after myocardial infarction (KOS-MI)
Authors: Buszman P P , Kolarczyk-Haczyk A , Konopko M , Mazur M , Przybyla P , Ciesielska K , Pietrzyk E , Hermasch M , Zurakowski A , Gasior M , Rogala M , Jankowski P , Kazmierczak P , Milewski K P , Buszman P E 
Published: October 2021

Abstract

Introduction
Despite significant progress in treatment of myocardial infarction (MI), the annual mortality remains a challenge. Since 2017, The Coordinated Care in Myocardial Infarction Program (KOS-MI) has been introduced in Poland, which guarantees and coordinates patients to achieve complete revascularization, electrotherapy when necessary, cardiac rehabilitation and access to cardiologist for patients after MI.

Purpose
The aim of this study was to assess long term outcomes (3-year follow-up) of patients enrolled in KOS-MI.

Methods
This is a prospective multicenter registry of 1973 consecutive patients with myocardial infarction hospitalized in 4 centers of American Heart of Poland from 11.2017 to 11.2018. Patients which constituted a study group were enrolled in KOS-MI program at discharge. A control group consisted patients who received standard of care. Propensity score matching was utilized for patients baseline characteristic matching and results adjustment. Follow-up was obtained from the National Health Fund registry citizens. Combine endpoint of MACCE consisted of death, MI, stroke and repeated revascularization.

Results
In total 753 patients were enrolled in KOS program and 1173 constituted a control group. More than 90% of patients in both groups underwent PCI. Patients in KOS-MI were mostly men (70% vs. 65%; p&lt;0,05), were younger (65 vs. 68; p&lt;0,05), admitted with STEMI (44,8% vs. 37,5%; p&lt;0,05) with previous history of heart failure (23% vs. 17%; p&lt;0,05). Patients in the control group had more comorbidities: chronic kidney disease (9,8% vs. 4,4%; p&lt;0,05), previous AMI (17,6% vs. 12,6%; p&lt;0,05), prior PCI (15,7% vs. 11%; p&lt;0,05) and atrial fibrillation (11,7% vs. 8,4%; p&lt;0,05). They were more often admitted with NSTEMI (62,5% vs. 55,3%; p&lt;0,05) and acute heart failure (4,7% vs. 2,7%; p&lt;0,05). KOS patients had more often completed revascularization performed (50% vs. 33,4%; p&lt;0,05). Following propensity score matching 576 pairs were matched, and patient baseline characteristic were well balanced in all variables.
In long- term follow-up (mean 2,8±0,27 years) mortality was significantly lower in KOS group (9% vs. 16,3%; p&lt;0,05) and MI similar (10,8% vs. 13,1%; p=0,14). MACCE was higher in the control group (43% vs. 30,2%; p&lt;0,05). Prevalence of hospitalization for HF and repeated revascularization was higher in the control group (14,7% vs. 9,4%; p&lt;0,05 and 27,9% vs. 21%; p&lt;0,05, respectively). After adjustment MACCE remained significantly lower for KOS-MI, whereas there was tendency for lower mortality, hospitalization for HF and repeated revascularizations (Figure 1).

Conclusions
Combination and coordination of unrestricted rehabilitation, complete revascularization, electrotherapy and ambulatory cardiologist care in the KOS-MI program improves long term prognosis in patients after MI.

Funding Acknowledgement
Type of funding sources: None. Figure 1