Grzegorz Kubielas1,2, Dorota Diakowska3, Izabella Uchmanowicz4,5. 1. Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland. izabella.uchmanowicz@umw.edu.pl. 2. Department of Health Care Services, Polish National Health Fund, Central Office in Warsaw, Warszawa, Poland. izabella.uchmanowicz@umw.edu.pl. 3. Department of Basic Sciences, Wroclaw Medical University, Wrocław, Poland. 4. Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland. 5. Center for Heart Diseases, University Hospital, Wrocław, Poland.
Abstract
BACKGROUND: This study aimed to analyze survival rates among patients with acute coronary syndrome (ACS) covered and not covered by the National Comprehensive Care after Myocardial Infarction (KOS-Zawał) program. METHODS: A total of 179972 patients after myocardial infarction (MI) were enrolled in KOS-Zawał program between October 2017 and March 2020 and were included in the comparative analysis with survival analysis. A group of 24496 (13.61%) patients received KOS-Zawał services, while a group of 155476 (86.39%) were not covered by the KOS-Zawał program. The time points for observation of the incidence of death were set at 30, 180, and 365 days from the end of the first hospitalization. RESULTS: There was a lower incidence of death in favor of the KOS-Zawał group relative to the non-KOS-Zawał group both in hospital and at 30, 180, and 365 days after the end of hospitalization, respectively: 0.19% vs. 6.55%; 0.80% vs. 8.39%; 2.92% vs. 10.74%; and 6.35% vs. 13.40%. Survival analysis revealed a statistically significantly lower (P <0.0001) probability of death in the KOS-Zawał group compared with the non-KOS-Zawał group. Also, logistic regression analysis confirmed that patients in the KOS-Zawał group had a significantly lower risk of death than those in the non-KOS-Zawał group (odds ratio, 0.710; 95% confidence interval, 0.554-0.908; P = 0.007). CONCLUSIONS: The KOS-Zawał comprehensive care program reduces the risk of death in the first year after MI by 29%. There are indications of a biased interpretation of the data due to the initial better clinical status of post-MI patients covered by the KOS-Zawał program.
BACKGROUND: This study aimed to analyze survival rates among patients with acute coronary syndrome (ACS) covered and not covered by the National Comprehensive Care after Myocardial Infarction (KOS-Zawał) program. METHODS: A total of 179972 patients after myocardial infarction (MI) were enrolled in KOS-Zawał program between October 2017 and March 2020 and were included in the comparative analysis with survival analysis. A group of 24496 (13.61%) patients received KOS-Zawał services, while a group of 155476 (86.39%) were not covered by the KOS-Zawał program. The time points for observation of the incidence of death were set at 30, 180, and 365 days from the end of the first hospitalization. RESULTS: There was a lower incidence of death in favor of the KOS-Zawał group relative to the non-KOS-Zawał group both in hospital and at 30, 180, and 365 days after the end of hospitalization, respectively: 0.19% vs. 6.55%; 0.80% vs. 8.39%; 2.92% vs. 10.74%; and 6.35% vs. 13.40%. Survival analysis revealed a statistically significantly lower (P <0.0001) probability of death in the KOS-Zawał group compared with the non-KOS-Zawał group. Also, logistic regression analysis confirmed that patients in the KOS-Zawał group had a significantly lower risk of death than those in the non-KOS-Zawał group (odds ratio, 0.710; 95% confidence interval, 0.554-0.908; P = 0.007). CONCLUSIONS: The KOS-Zawał comprehensive care program reduces the risk of death in the first year after MI by 29%. There are indications of a biased interpretation of the data due to the initial better clinical status of post-MI patients covered by the KOS-Zawał program.