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Impact of the Regional Network for AMI in the Management of STEMI on Care Processes, Outcomes and Health Inequities in the Veneto Region, Italy

Author

Listed:
  • Mario Saia

    (Medical Directorate, ULSS 6 Euganea, Veneto Region, Via Enrico degli Scrovegni 14, 35131 Padua, Italy)

  • Domenico Mantoan

    (Health and Social Services, Veneto Region, Dorsoduro, 3493—Rio Nuovo, 30123 Venice, Italy)

  • Marco Fonzo

    (School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Chiara Bertoncello

    (Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Marta Soattin

    (School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Milena Sperotto

    (Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Tatjana Baldovin

    (Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Patrizia Furlan

    (Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Maria Luisa Scapellato

    (Department of Cardiological, Thoracic and Vascular Sciences, Occupational Medicine Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Guido Viel

    (Department of Cardiological, Thoracic and Vascular Sciences, Legal Medicine Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Vincenzo Baldo

    (Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Silvia Cocchio

    (Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

  • Alessandra Buja

    (Department of Cardiological, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Via Loredan 18, 35128 Padua, Italy)

Abstract

Cardiovascular diseases are a leading cause of death in Europe. Outcomes in terms of mortality and health equity in the management of patients with ST-Elevation Myocardial Infarction (STEMI) are influenced by health care service organization. The main aim of the present study was to examine the impact of the new organizational model of the Veneto Region’s network for Acute Myocardial Infarction (AMI) to facilitate primary percutaneous coronary intervention (PCI) on STEMI, and its efficacy in reducing health inequities. A retrospective cohort study was conducted on HDRs in the Veneto Region for the period 2007–2016, analyzing 65,261 hospitalizations for AMI. The proportion of patients with STEMI treated with PCI within 24 h increased significantly for men and women, and was statistically much higher for patients over 75 years of age (APC, 75–84: 9.8; >85: 12.5) than for younger patients (APC, <45: 3.3; 45–64: 4.9), with no difference relating to citizenship. The reduction in in-hospital, STEMI-related mortality was only statistically significant for patients aged 75–84 (APC: −3.0 [−4.5;−1.6]), and for Italians (APC: −1.9 [−3.2;−0.6]). Multivariate analyses confirmed a reduction in the disparities between socio-demographic categories. Although the new network improved the care process and reduced health care disparities in all subgroups, these efforts did not result in the expected survival benefit in all patient subgroups.

Suggested Citation

  • Mario Saia & Domenico Mantoan & Marco Fonzo & Chiara Bertoncello & Marta Soattin & Milena Sperotto & Tatjana Baldovin & Patrizia Furlan & Maria Luisa Scapellato & Guido Viel & Vincenzo Baldo & Silvia , 2018. "Impact of the Regional Network for AMI in the Management of STEMI on Care Processes, Outcomes and Health Inequities in the Veneto Region, Italy," IJERPH, MDPI, vol. 15(9), pages 1-14, September.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:9:p:1980-:d:169068
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    References listed on IDEAS

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    1. Terje P. Hagen & Unto Häkkinen & Tor Iversen & Søren Toksvig Klitkou & Tron Anders Moger & on behalf of the EuroHOPE study group, 2015. "Socio‐economic Inequality in the Use of Procedures and Mortality Among AMI Patients: Quantifying the Effects Along Different Paths," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 102-115, December.
    2. Terje P. Hagen & Unto Häkkinen & Tor Iversen & Søren Toksvig Klitkou & Tron Anders Moger & on behalf of the EuroHOPE study group, 2015. "Socio‐economic Inequality in the Use of Procedures and Mortality Among AMI Patients: Quantifying the Effects Along Different Paths," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 102-115, December.
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