Abstract
Post-discharge management of patients after Acute Myocardial Infarction (AMI) requires a comprehensive outpatient network and adequate follow-up strategies: this combination should allow a significant outcome improvement with secondary events. The aim of this study was to investigate the current post discharge management of AMI patients across Italian regions in the last years, by examining regional guidelines and outcome indicators. A research was conducted to gather national outcome index (30-day mortality and 1-year mortality after AMI events) developed by Piano Nazionale Esiti (PNE), based on hospital discharge records (HDRs) during 2016 and collected by hospital administrative claim database. Furthermore, regional guidelines and PDTA documents from 2012 until 2017ere collected through a desk research to gain information about AMI patient journey in all available settings and phases. From 2010 to 2016 30-days after AMI mortality index decreased from 9,52% (2010) to 7,9% (2016); in the same period, 1-year after AMI mortality index was steady over the years, ranging from 10,66% (2010) to 10,17% (2016). After the hospital discharge due to an AMI event, every patient requires an adequate cardiac rehabilitation program, but a limited percentage of patients (between 12% and 18%) received the follow up support in dedicated structures. Moreover, few guidelines and PDTA mentioned the follow up phase in the outpatient setting, while the majority focused mostly on management and treatment of the acute phase in the emergency setting. Although the AMI management has been improved in the recent years especially for the acute treatment phase, the transition from the hospital to the territorial setting is not aligned with the effectiveness of the hospital care. Along this, guidelines and PDTA could be enhanced focusing on the design of the patient journey after hospital discharge, to improve the management of AMI patients in the long term.
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