Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Myocardial Infarction

Pokorney, Sean D.; Miller, Amy; Chen, Anita Y.; Thomas, Laine; Fonarow, Gregg C.; Lemos, James A. de; Al‐Khatib, Sana M.; Velázquez, Eric J.; Peterson, Eric D.; Wang, Tracy Y.

doi:10.1161/circulationaha.116.022359

Cited by 15 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The result of the real world registries, however, show that only a fraction of eligible patients is offered a device therapy. The report by Pokorney et al showed that only 2/3 of the post-MI population with reduced EF at baseline have echo reassessment within 12 months, and even in persistently reduced EF, the device treatment is offered to only 11% of eligible patients [ 21 ]. Our results confirm that obligatory EF assessment triples the number of patients referred to ICD/CRT implantation (MC-AMI: 4.3% vs. control 1.4%.…”

Section: Discussionmentioning

confidence: 99%

Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis

Wita

Kułach

Sikora

et al. 2020

JCM

View full text Add to dashboard Cite

Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland’s National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up. Methods: MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression. Results: MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42–0.65, p < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction. Conclusions: Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed.

show abstract

Section: Discussionmentioning

confidence: 99%

Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis

Wita

Kułach

Sikora

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…Our findings underscore that careful post-AMI reassessments are required to monitor the LVEF trajectory and identify potential patients who need additional medical and/or device therapies, even in patients with preserved LVEF at the time of AMI. However, despite guideline-directed recommendations (23,24), previous studies have shown that the frequency of post-AMI LVEF reassessment was relatively low in patients with LV systolic dysfunction at the time of AMI (25,26). A recent cohort study from Canada also demonstrated that approximately 1 in 3 patients with mildly reduced LVEF following AMI did not undergo LVEF reassessment within 6 months after AMI (27).…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of incident left ventricular systolic dysfunction after myocardial infarction

Yoshioka

Tanaka²,

Watanabe³

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

IntroductionWe sought to investigate the prognostic impact of incident left ventricular (LV) systolic dysfunction at the chronic phase of acute myocardial infarction (AMI).Materials and methodsAmong 2,266 consecutive patients admitted for AMI, 1,330 patients with LV ejection fraction (LVEF) ≥ 40% during hospitalization who had LVEF data at 6 months after AMI were analyzed. Patients were divided into three subgroups based on LVEF at 6 months: reduced-LVEF (<40%), mid-range-LVEF (≥ 40% and < 50%) and preserved-LVEF (≥ 50%). Occurrence of a composite of hospitalization for heart failure or cardiovascular death after 6 months of AMI was the primary endpoint. The prognostic impact of LVEF at 6 months was assessed with a multivariate-adjusted Cox model.ResultsOverall, the mean patient age was 67.5 ± 11.9 years, and LVEF during initial hospitalization was 59.4 ± 9.1%. The median (interquartile range) duration of follow-up was 3.0 (1.5–4.8) years, and the primary endpoint occurred in 35/1330 (2.6%) patients (13/69 [18.8%] in the reduced-LVEF, 9/265 [3.4%] in the mid-range-LVEF, and 13/996 [1.3%] in the preserved-LVEF category). The adjusted hazard ratio for the primary endpoint in the reduced-LVEF vs. mid-range-LVEF category and in the reduced-LVEF vs. preserved-LVEF category was 4.71 (95% confidence interval [CI], 1.83 to 12.13; p < 0.001) and 14.37 (95% CI, 5.38 to 38.36; p < 0.001), respectively.ConclusionIncident LV systolic dysfunction at the chronic phase after AMI was significantly associated with long-term adverse outcomes. Even in AMI survivors without LV systolic dysfunction at the time of AMI, post-AMI reassessment and careful monitoring of LVEF are required to identify patients at risk.

show abstract

“…These Canadian results in fact compare favorably with those reported by the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines in a study of US Medicare-insured post-MI patients with in-hospital LVEF less than or equal to 35%, of whom 66.8% had LVEF reassessment within 1 year. 12 …”

Section: Discussionmentioning

confidence: 99%

“…US-based cohorts have also documented lower than expected rates of LVEF reassessment in similar patient populations. 11,12 This is an important gap in care because, despite guideline-directed medical therapy and revascularization, up to 50% of patients with impaired LVEF after MI do not experience normalization of their ventricular function. 13,14 Previous studies on this topic have been retrospective and lacked patient-reported data on the potential reasons for lack of follow-up testing.…”

Section: Introductionmentioning

confidence: 99%

Variability in Reassessment of Left Ventricular Ejection Fraction After Myocardial Infarction in the Acute Myocardial Infarction Quality Assurance Canada Study

et al. 2021

View full text Add to dashboard Cite

Key Points Question What proportion of patients with left ventricular dysfunction identified during hospitalization for acute myocardial infarction have follow-up assessment of left ventricular ejection fraction (LVEF)? Findings In this cohort study of 501 patients, 303 patients had undergone LVEF reassessment by 6 months, with significant variability according to patient-level and site-level characteristics. Meaning These findings suggest that programs to improve the quality of post–myocardial infarction care should include measures to ensure that indicated repeat cardiac imaging is performed.

show abstract

Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Myocardial Infarction

Cited by 15 publications

References 32 publications

Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis

Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis

Prognostic impact of incident left ventricular systolic dysfunction after myocardial infarction

Variability in Reassessment of Left Ventricular Ejection Fraction After Myocardial Infarction in the Acute Myocardial Infarction Quality Assurance Canada Study

Contact Info

Product

Resources

About