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Patients with heart failure and reduced ejection fraction: A sub-analysis from the 3-year Coordinated Myocardial
Marta Mazur1,2, Aleksandra Kolarczyk-Haczyk3, Łukasz Konarski3
1Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Bielsko Biała, Poland. pbuszman@gmail.com.
Insights
The Coordinated Care Program after Myocardial Infarction (KOS-MI) significantly reduced major adverse events and mortality in heart failure patients post-MI. This comprehensive care program shows promise for improving outcomes in heart failure management.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- The Coordinated Care Program after Myocardial Infarction (KOS-MI) demonstrated success in Poland, improving patient prognosis and gaining international recognition.
- Its methodology presents a potential model for enhancing care in heart failure (HF) populations.
Purpose of the Study:
- To evaluate the effectiveness of a KOS-MI-like program for patients with heart failure (HF) following myocardial infarction (MI).
- To analyze the impact on major adverse cardiovascular and cerebrovascular events and mortality over a 3-year follow-up period.
Main Methods:
- A multicenter retrospective study involving 1972 patients hospitalized for MI.
- Comparison of outcomes between patients participating in the KOS-MI program (n=963) and non-participants.
- Propensity score matching created 127 pairs of participants and non-participants for adjusted analysis, focusing on patients with reduced ejection fraction HF (HFrEF).
Main Results:
- KOS-MI participants experienced a 57% reduction in major adverse cardiovascular and cerebrovascular events and a 67% reduction in mortality at 3-year follow-up.
- A 42% decrease in hospital admissions for HF was observed in the KOS-MI group.
- After propensity score matching and adjustment, a significant reduction in the risk of death (HR 0.02) was noted, while other outcomes like MI, stroke, and revascularization showed no significant differences.
Conclusions:
- The KOS-MI program significantly enhances prognosis for heart failure with reduced ejection fraction (HFrEF) patients up to three years post-treatment.
- The findings support the implementation of dedicated, comprehensive care programs for heart failure patients to improve long-term outcomes.
Background:
The Coordinated Care Program after Myocardial Infarction (KOS-MI) implemented in Poland has shown significant improvement in patient prognosis, ended in nationwide success, and got international attention. A similar program and methodology may be an attractive option for patients with heart failure (HF).
Aims:
This study aimed to analyze whether a similarly structured program would also be beneficial for HF patients after myocardial infarction.
Methods:
This is a multicenter retrospective study of 1972 patients hospitalized for MI. Almost half of patients (n = 963, 48.8%) participated in the KOS-MI program. In the total population, 467 patients presented with reduced ejection fraction HF (HFrEF ≤40%), and 237 (50.7%) participated in the program. Major adverse cardiovascular and cerebrovascular events were evaluated at a 3-year follow-up. Multivariate independent risk analysis was performed. We used propensity score matching for participants and non-participants in the KOS-MI program, resulting in 127 pairs.
Results:
A 3-year follow-up (completed by 93% of patients), there was a 57% reduction in major adverse cardiovascular and cerebrovascular events (HR, 0.43; 95% CI, 0.31-0.6; P <0.001), 67% in mortality (HR, 0.33; 95% CI, 0.22-0.5; P <0.001), and 42% in hospital admissions for HF (HR, 0.58; 95% CI, 0.4-0.9; P <0.007) in the KOS-MI patients. There was no difference in the occurrence of MI (HR, 0.71; 95% CI, 0.37-1.34; P = 0.29), stroke (HR, 0.9; 95% CI, 0.18-4.45; P = 0.89), and repeated revascularization (HR, 0.6; 95% CI, 0.34-1.05; P = 0.07). Following propensity score matching 127, well-matched pairs between groups were created. Following adjustment, there was a statistically significant reduction in the risk of death (HR, 0.02; 95% CI, 0.29-0.89; P = 0.02) while other parameters were similar.
Conclusions:
The KOS-MI program significantly improved HFrEF patients' prognosis up to 3 years post-treatment, even after its cessation after one year. Thus, implementing a dedicated comprehensive care program for HF patients is warranted.
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