[Coordinated care after myocardial infarction. The statement of the Polish Cardiac Society and the Agency for Health Technology Assessment and Tariff System]

Abstract

The in-hospital mortality following myocardial infarction has decreased substantially over the last two decades in Poland. However, according to the available evidence approximately every 10th patient discharged after myocardial infarction (MI) dies during next 12 months. We identified the most important barriers (e.g. insufficient risk factors control, insufficient and delayed cardiac rehabilitation, suboptimal pharmacotherapy, delayed complete myocardial revascularisation) and proposed a new nation-wide system of coordinated care after MI. The system should consist of four modules: complete revascularisation, education and rehabilitation programme, electrotherapy (including ICDs and BiVs when appropriate) and periodical cardiac consultations. At first stage the coordinated care programme should last 12 months. The proposal contains also the quality of care assessment based on clinical measures (e.g. risk factors control, rate of complete myocardial revascularisation, etc.) as well as on the rate of cardiovascular events. The wide implementation of the proposed system is expected to decrease one year mortality after MI and allow for better financial resources allocation in Poland.

Keywords: angioplasty; coronary artery disease; electrotherapy; myocardial infarction; prevention; rehabilitation.