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Int J Cardiol. 2018 Jan 15;251:1-7. doi: 10.1016/j.ijcard.2017.10.048. Epub 2017 Oct 22.

Physician specialty and long-term survival after myocardial infarction - A study including all German statutory health insured patients.

Author information

1
Kassenärztliche Bundesvereinigung (KBV), National Association of Statutory Health Insurance Physicians, Herbert-Lewin-Platz 2, 10623 Berlin, Germany; Charité Universitätsmedizin Berlin, Institute of Public Health, Seestr. 73, Haus 10, 13347 Berlin, Germany. Electronic address: Maria.Radzimanowski@Charite.de.
2
Kassenärztliche Bundesvereinigung (KBV), National Association of Statutory Health Insurance Physicians, Herbert-Lewin-Platz 2, 10623 Berlin, Germany.
3
Charité Universitätsmedizin Berlin, Institute of Public Health, Seestr. 73, Haus 10, 13347 Berlin, Germany.

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 18months, 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 (χ2=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.

KEYWORDS:

Ambulatory care; Cardiologist; Medical claims data; Mortality; Myocardial infarction

PMID:
29092757
DOI:
10.1016/j.ijcard.2017.10.048
[Indexed for MEDLINE]
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