Valeria Belleudi
Lazio Regional Health Service, Italy
Title: One-year survival after Acute Myocardial Infarction (AMI): The effect of care-pathway in Italy
Biography
Biography: Valeria Belleudi
Abstract
The relationship between guide-lines adherence and outcomes in patients with AMI has been widely investigated considering the phases (emergency, acute, post-acute) of the Care-Pathway (CP) separately. This research aims to evaluate the effect of the whole AMI-CP on 1-year survival.
We conducted a cohort study, selecting AMI patients from health information systems during 2011-13. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. For each subject the probability to arrive in hospital and conditional probabilities to survive to acute and post-acute phases were estimated through multivariate models. One-year survival probability was calculated as the product of the three probabilities.
Different scenarios of CP quality were defined in terms of emergency-timeliness, hospital performance in treatment of acute phase and drug therapy in post-acute phase. One-year survival Probability Ratio (PR) and its Bootstrap Confidence Intervals (BCI) between who effected the best CP and who effected the worst were calculated for a mean-severity patient and varying sex and age.
We identified 29392 AMI. Out-of-hospital mortality was 27.9%. Among people arrived in hospital, 41.4% had a hospitalization for STEMI with 11.3% of mortality in acute-phase and 5.6% in post-acute phase. For a patient of mean-severity the PR was 1.39 (BCI 1.26-1.60). The ratio didn’t change by sex, while it moved from 1.13 (BCI 1.09-1.20) for age85.
One-year survival probability post AMI depends strongly on CP. Improving performance in the different phases, taking into account the relationship among these, can lead to considerable savings of lives.