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- Title
Myocardial infarction patients referred to the primary care physician after 1‑year treatment according to a guideline-based protocol have a good prognosis.
- Authors
Bodde, M. C.; van Hattem, N. E.; Abou, R.; Mertens, B. J. A.; van Duijn, H. J.; Numans, M. E.; Bax, J. J.; Schalij, M. J.; Jukema, J. W.
- Abstract
Introduction: Identifying ST-elevation myocardial infarction (STEMI) patients who can be referred back to the general practitioner (GP) can improve patient-tailored care. However, the long-term prognosis of patients who are returned to the care of their GP is unknown. Therefore, the aim of this study was to assess the long-term prognosis of patients referred back to the GP after treatment in accordance with a 1-year institutional guideline-based protocol. Methods: All consecutive patients treated between February 2004 up to May 2013 who completed the 1‑year institutional MISSION! Myocardial Infarction (MI) follow-up and who were referred to the GP were evaluated. After 1 year of protocolised monitoring, asymptomatic patients with a left ventricular ejection fraction >45% on echocardiography were referred to the GP. Long-term prognosis was assessed with Kaplan-Meier curves and Cox proportional hazards analysis was used to identify independent predictors for 5‑year all-cause mortality and major adverse cardiovascular events (MACE). Results: In total, 922 STEMI patients were included in this study. Mean age was 61.6 ± 11.7 years and 74.4% were male. Median follow-up duration after the 1‑year MISSION! MI follow-up was 4.55 years (interquartile range [IQR] 2.28–5.00). The event-free survival was 93.2%. After multivariable analysis, age, not using an angiotensin-converting enzyme (ACE) inhibitor/angiotensin-II (AT2) antagonist and impaired left ventricular function remained statistically significant predictors for 5‑year all-cause mortality. Kaplan-Meier curves revealed that 80.3% remained event-free for MACE after 5 years. Multivariable predictors for MACE were current smoking and a mitral regurgitation grade ≥2. Conclusion: STEMI patients who are referred back to their GP have an excellent prognosis after being treated according to the 1‑year institutional MISSION! MI protocol.
- Subjects
MYOCARDIAL infarction treatment; HEART disease prognosis; MYOCARDIAL infarction diagnosis; ECHOCARDIOGRAPHY; PRIMARY care
- Publication
Netherlands Heart Journal, 2019, Vol 27, Issue 11, p550
- ISSN
1568-5888
- Publication type
Article
- DOI
10.1007/s12471-019-01316-w