Postdischarge continuity of care and cardiovascular outcomes in acute coronary syndrome
Yi-Cheng Lin, Chien-Yi Hsu, Chih-Wei Chen, Bi-Li Chen, Ling-Ya Huang, Chia‐Li Chang, Satoshi Yasuda, Myung Ho Jeong, Satoshi Honda, Wei Chun Huang, Yu-Chen Wang, Yu-Hsuan Joni Shao, Chun-Yao HuangBackground:
Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Despite the availability of guideline-directed medical therapy (GDMT), postdischarge continuity of care (CoC) remains suboptimal, and evidence from Asian health-care systems remains limited. The present study examined the association between CoC and clinical outcomes in Taiwanese patients with ACS.
Methods:
This nationwide observational cohort study was conducted using data from Taiwan’s National Health Insurance Research Database. It included patients who had their first ACS-related hospitalization between 2012 and 2020 and excluded those who died during the index hospitalization or experienced study outcomes within 1 month after discharge. CoC was assessed in terms of physician, specialty, and GDMT continuity. Study outcomes were all-cause mortality, major adverse cardiovascular events (MACEs), hospitalization for heart failure (HHF), and major bleeding.
Results:
This study included 140 214 patients with ACS. Patients with low physician continuity had significantly higher risks of all-cause mortality (adjusted risk ratio [aRR]: 2.20, 95% confidence interval [CI] 2.09 to 2.31), cardiovascular death (aRR: 1.97, 95% CI: 1.81 to 2.15), MACEs (aRR: 1.78, 95% CI: 1.66 to 1.90), HHF (aRR: 1.66, 95% CI: 1.54 to 1.78), and major bleeding (aRR: 1.45, 95% CI: 1.26 to 1.66) than did those with high physician continuity. Low specialty continuity was associated with a 1.28-to-1.95-fold increase in the risk of adverse outcomes. Furthermore, low GDMT continuity was significantly associated with elevated risks of all-cause mortality, cardiovascular death, and MACEs but not HHF or major bleeding.
Conclusion:
The findings suggest that lower CoC during the first year after ACS-related hospitalization is associated with poorer clinical outcomes. Future studies should explore strategies to improve CoC.