Physician specialty and long-term survival after myocardial infarction — A study including all German statutory health insured patients. (15th January 2018)

• Record Type: Journal Article
• Authors: Radzimanowski, Maria; Gallowitz, Christian; Müller-Nordhorn, Jacqueline; Rieckmann, Nina; Tenckhoff, Bernhard
• Is Part Of: International journal of cardiology. Volume 251(2018)
• Page Start: 1
• Page End: 7
• Publication Date: 2018-01-15
• Subjects: Myocardial infarction -- Ambulatory care -- Cardiologist -- Mortality -- Medical claims data; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.10.048
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: With a mortality rate above European average, myocardial infarction (MI) is the second most common cause of death in Germany. Data about post-MI ambulatory care and mortality is scarce. We examined the association between ambulatory treating physicians' specialty and the mortality of post-MI patients. Methods: Medical claims data of all 17 German regional Associations of Statutory Health Insurance physicians were analyzed, which cover approximately 90% of the German population. Patients with a new diagnosis of a MI in 2011 were divided into treatment groups with and without ambulant cardiology care within the first year after MI diagnosis. Propensity-score matching based on socio-demographic and clinical variables was performed to achieve comparability between groups. The 18-month mortality rate was derived employing a validated method. Results: 158, 494 patients with a new diagnosis of MI had received post-MI ambulatory care in 2011. Half of them (51%) had at least one ambulatory contact with a cardiologist within the first year. During a follow-up of 18 months, the mortality rate before and after propensity-score matching was 19% and 14% in patients without cardiology care and 6%, respectively, in patients with cardiology care (χ 2 = 666.7; P < 0.000 after propensity adjustment). Patients who only saw a cardiologist and had no additional contact to an ambulant general practitioner (GP)/internist within the first year did not have increased survival rates. Conclusions: Outpatient follow-up care by a cardiologist in combination with consultations of GP/internists within the first year may be of importance for the prognosis of MI patients.