Post-myocardial infarction patient pathways in Portugal

Abstract

Acute myocardial infarction (AMI) is a condition that affects 12 000 Portuguese individuals annually. In Portugal, disease management foresees three levels of services according to the Cardiology Referral Network. This study aims to characterize the path taken by AMI patients in Portugal after hospital treatment, at the different hospital levels. Subsequently, it aims to propose recommendations for improvements. A Steering Committee, composed of cardiology experts in AMI was responsible for the project methodology. A literature review was performed to systematize national and international AMI guidelines, followed by structured interviews of stakeholders involved in the management of these patients in seven hospitals different levels in Portugal. The study ended with a consensus meeting to analyze the results and develop recommendations. Regarding communication and liaison between hospitals in the referral network: a clear distinction was observed between hospitals in urban areas with a relatively small referral area for level 2 services versus inland hospitals, to which patients from broader areas were referred. From the point of view of communication between professionals regarding the patient's clinical information, only in level 3 hospitals in the referral network was there a greater interconnection of systems and consequent greater ease in information flows. The latter had structured cardiac rehabilitation programs, which included the integration of in-house and community facilities, in line with European Society of Cardiology recommendations. Finally, regarding the frequency of post-discharge hospital follow-up and the professionals involved, in most hospitals, follow-up was reported with the first visit at three months post-discharge, and then repeated, on average, every six months for a period between one and two years in non-atypical patients. There is high variability in the support and practices implemented to promote secondary prevention of AMI at different hospitals levels in Portugal. There is a need to review the patient pathway considering follow-up by Cardiology in the referring hospital until discharge from the consultation to a General Practitioner; implementation of Smoking Cessation Programs; Nutrition; Psychology and Physical Therapy, adjusted to the different hospital levels. Implementation of a cardiac rehabilitation program is key.