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

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

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.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / methods
  • Ambulatory Care / trends*
  • Cardiologists / trends*
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Humans
  • Insurance, Health / trends*
  • Male
  • Medicine / methods
  • Medicine / trends
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / therapy*
  • Physicians / trends
  • Propensity Score
  • Survival Rate / trends