Patients with heart failure and reduced ejection fraction: A sub-analysis from the 3-year Coordinated Myocardial Infarction Care Program (KOS-MI) registry.

Abstract

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). This study aimed to analyze whether a similarly structured program would also be beneficial for HF patients after myocardial infarction. 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. 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. 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.