The Impact of multicomponent Integrated care on the long-term prognosis after acute coronary syndrome: A meta-analysis

ABSTRACT

Background: There were reports on lower rates of hospitalization for acute coronary syndrome during COVID-19 pandemic due to fear to attend to hospitals, resulting in delayed diagnosis and treatment. In addition to fragmented care, hospital capacity strain affects access to care continuity for patients with acute coronary syndrome. Aim: To examine the impact of multicomponent integrated care on hard clinical outcomes in patients with acute coronary syndrome. Method: A literature search was conducted on PubMed, EMBASE, Ovid and Cochrane library databases for randomized controlled trials published in English language between January 1980 and November 2020. Trials were eligible if there was intervention with multicomponent integrated care, defined as 2 or more quality improvement strategies targeting different domains (the healthcare system, health-care providers and patients), for 1 month or more among patients with acute coronary syndrome. The outcomes of interest were mortality, hospital re-admission and emergency department visits, stratified by all-cause and cardiovascular-related. We pooled the risk ratio (RR) with 95% confidence interval (CI) for the association between multicomponent integrated care and clinical outcomes using the Mantel-Haenszel test. Results: We identified a total of 74 eligible trials with 92,625 patients with acute coronary syndrome. The most common quality improvement strategies implemented were team change (83.8%), patient education (62.2%) and facilitated patient-provider relay (54.1%). In random-effect models, compared with usual care, multicomponent integrated care was associated with reduced risk for all-cause mortality (RR 0.84, 95% CI 0.78-0.90;p<0.001;I2=0%), cardiovascular mortality (RR 0.81, 95% CI 0.69-0.95;p=0.009;I2=0%), all-cause hospitalization (RR 0.88, 95% CI, 0.78-0.99;p=0.040;I2=58%) and cardiovascular-related hospitalization (RR 0.89, 95% CI 0.77-1.03;p=0.110;I2=79%). The associations of multicomponent integrated care with emergency department visits (RR 0.98, 95% CI 0.81-1.19;p=0.860;I2=66%) and unplanned outpatient visits (RR 1.03, 95% CI 0.90-1.18;p=0.650;I2=40%) were not statistically significant. Discussion: Multicomponent integrated care can improve patients’ outcomes after acute coronary syndrome. Patients with acute coronary syndrome need to understand their condition, adhere to treatment and perform self-management to prevent recurrence with worse prognosis. Our findings highlight that multicomponent integrated care can reduce risk for mortality and hospitalization in these high-risk patients.