Volume 3, Issue 8
The positive stable frailty model application to assess survival effect of health care reform on patients with acute myocardial infarction
Author: Ocheredko Oleksandr, Klimenyk Volodimir
Abstract: Background: notoriously known worldwide leading cause of disability and mortality in adults cardiovascular diseases experience their rise in Ukraine, taking formidable death tall of 37 960 people with vicious rate 1 person per minute being the highest among European countries. Acute myocardial infarction (AMI) leads the way. The aim was to unveil the impact of ongoing health care reform to survival of patients with AMI incident in Vinnitsa region, Ukraine. Data: organised by cohort design. Control cohort comprised 400 patients with first episode of AMI treated in cardiological 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 the centre. Diagnoses comprised ICD-10 codes ?21.0-?21.3, ?21.4, ?21.9, ?22. The most pervasive localization happened to be anterior (33,2%), posterior (37,4%), and frontolateral (12,0%). AMI-related 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%. Methods: positive stable frailty model processed by SAS macro. Results: after adjustment on important clinical and biological confounders the implementation of reform rendered hazard reduction effect of the largest magnitude among other covariates (b=-0,179, ?=0,029). Basic risk of lethality because of reform dropped by 19,6%, saving 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.
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