Effectiveness of Implementation of the Model of Medical Care to Patients with Acute Myocardial Infarction in the Process of Medical Reform in Vinnitsa Region, Ukraine

Klimenyk V. Р. , Ocheredko O. M.

SOCIAL MEDICINE AND ORGANIZATION OF HEALTHCARE PROTECTION

Scentific article

Paper delivers methodological peculiarities and results on effectiveness of implementation of medi- cal care on 5-years survival of patients with acute myocardial infarction (AMI) on the basis of frailty model. Data were organised by cohort design. Control cohort comprised 400 patients with first episode of AMI treated in cardiologi- cal Vinnitsa city department on the eve of reform, namely 2005-2006 years. Experimental cohort consisted of 400 patients with first episode of AMI treated in Vinnitsa regional cardiological centre in 2008-2009 years at the moment of reform initiation and opening of foregoing centre. Reform brought intensive methods of AIM treatment at hand. Lethal cases happened in first 5 years from the hospitalization were investigated. In given time period 270 out of 800 patients died, that is 33,7 %. It was revealed that implementation of reform rendered hazard reduction effect of the largest magnitude among other covariates (b = -0,179, р = 0,029). Basic risk of lethality because of reform dropped by 19,6 % ([1/ RR-1]*100 %), RR = 0,836. Among all organisational functionals of medical care it appeared that it’s timeliness that of paramount impor- tance in hazard reduction in patients with AIM. If patient was hospitalised with 10 hours delay or more basic risk of lethality increased by 43,6 %. Effectiveness of trombolytic therapy and stenting closely related to timeliness of administration, especially to first 10-12 hours. Administration of trombolytic therapy in first 10-12 hours reduced basic risk of lethality by 26,6 %, while timely stenting reduced hazard by 31,1 %. Severe patient’s condition at hospitalization increased basic risk of lethality by 21,8 %. Heavy comorbidity load (Charlson’s index > = 5) increased basic risk of lethality by 19,6 % with marginal significance р = 0,074. Low ejection fraction (values < = 0,3 %) at hospitalization increased basic risk of lethality by 39,5 %. Values of systolic blood pressure more than 170 mm. Hg at hospitalization increased basic hazard by 37,8 %. Presence of pathological Q related to increased risk against basic hazard by 18,4 %. Heart arrest before or at hospitalization increased basic risk of lethality by 62,1 % with marginal significance р = 0,05. As with Charlson’s index marginal significance related to low frequency of conditions. Every next year of age after 40 increased risk against basic hazard by 1,3 %. Females experienced higher (by 31,7 %) hazard against males ([1/0,759-1]*100 %). Therefore after adjustment on important clinical and biological confounders the implementation of the model of medical care to patients with acute myocardial infarction in the process of medical reform proved to reduce basic hazard significantly. Further investigation of survival curves revealed that implementation of the model saved additional 0,8788 survival months to patient in first 5 years from AMI incident. It was unveiled that main effect (84,2 %) was related particularly to improvement in timeliness of medical care.

acute myocardial infarction, survival, medical reform

• Богатирьова Р. В. Регіональна оцінка реформи системи медичного забезпечення сільського населення при екстрених станах, / Р. В. Богатирьова, А. В. Пірникоза. – Вінниця :0

«Bulletin of problems biology and medicine» Issue 4 part 1 (113), 2014 year, 328-334 pages, index UDK 614. 2:517. 004. 13:519. 46(014)