Mortality in patients after acute myocardial infarction managed by cardiologists and primary care physicians: a systematic review
Polish Archives of Internal Medicine
Mortality following acute myocardial infarction (AMI) remains high despite of progress in invasive and non-invasive treatments. To compare the outcomes of ambulatory treatment by cardiologists versus treatment by general practitioners (GPs) in post-AMI patients. We conducted a systematic search in 3 electronic databases for interventional and observational studies, which reported all-cause mortality, mortality from cardiovascular causes, strokes and myocardial infarctions in long term
... n following AMI. We assessed the risk of bias of the included studies using ROBINS-I for non-randomized studies of interventions, we also planned to use RoB 2.0 for randomized trials. Two non-randomized studies fulfilled the inclusion criteria. We assessed these studies as having moderate risk of bias. We did not pool the results due to significant heterogeneity between studies. Patients consulted by both a cardiologist and a GP had lower risk of all-cause death as compared to patients consulted by a cardiologist only (RR = 0.92, 95% CI = 0.85-0.99). Patients consulted by a cardiologist with or without GP had lower risk of all-cause death compared to patients consulted by GP only in both studies (RR = 0.80, 95% CI = 0.75-0.85 and RR = 0.44, 95% CI = 0.41-0.47). Patients after AMI consulted by both a cardiologist and a GP may have lower risk of death compared to patients consulted by a GP or a cardiologist only, however these findings are based on moderate quality non-randomized studies. We found no evidence on the relation between the specialization of the physician and the risk of cardiovascular death, stroke or myocardial infarction in AMI survivors.