Effects of standard observation and its combination with active medical monitoring in patients with myocardial infarction with various dietary patterns

Abstract

   Aim of the study was to investigate the effects of standard observation and its evaluation with active physician monitoring (APM) in patients with myocardial infarction (MI) under different dietary patterns.   Material and methods. The prospective interventional study initially included 170 patients living in the city of Kemerovo and the Kemerovo Municipal District who were urgently hospitalized at the Kemerovo Clinical Cardiology Clinic with a diagnosis of MI. On days 3–5 of hospital stay, nutrition for the month preceding the MI was assessed using a questionnaire using the questionnaire “Semi-quantitative assessment of the frequency of food consumption by the adult population.” Using factor analysis using the method of principal components, the main nutritional stereotypes of patientswith MI were identified: protein-fat (n = 40, 23.5 %), fruit and cereal (n = 52, 30.6 %), milk-carbohydrate (n = 51, 30.0 %), mixed (n = 27, 15.9 %). Before discharge, 150 patients were randomized into groups: standard outpatient observation (n = 75) and its combination with APM (n = 75), and 20 patients were excluded due to lack of access to Telegram app or refusal to further participate in the study. APM meant telephone calls to patients (at least once a month) and the sending of medical recommendations on secondary prevention issues through the Telegram channel (2–3 times a week). After 1 year, in each of the groups of patients with MI, having different dietary patterns, the end points were compared: for all – the frequency of deaths, for the living – emergency hospitalizations for ischemic events, as well as adherence to treatment and regular outpatient monitoring, achievement of target cardiovascular parameters – vascular health (blood pressure (BP), resting heart rate (HR), low-density lipoprotein (LDL)).   Results. When comparing the results of standard outpatient observation and the combination with APM within a year after MI, it was revealed that patients with a combination of standard outpatient observation and APM had 4.75 times fewer emergency hospitalizations for cardiovascular reasons (p < 0.001), a trend towards fewer the number of deaths due to cardiovascular causes (p = 0.053), and the combined end point (death + emergency cardiovascular hospitalizations) was recorded 4.8 times less frequently. In patients from the groups of standard outpatient follow-up and its combination of APM and standard outpatient follow-up for a year after MI, regardless of dietary pattern, there were no significant differences in the frequency of deaths and emergency hospitalizations for ischemic events, adherence to prognosis-improving therapy, the proportion of those achieving target blood pressure, and heart rate. However, during this observation, patients who had a fruit-cereal diet before MI were more likely to report regular outpatient visits during the year post-MI (p = 0.009), and patients with a protein-fat diet were more likely to subsequently achieve target LDL level (p = 0.001). Among patients who had only standard follow-up, adherence to follow-up, therapy, and achievement of cardiovascular health goals, as well as the incidence of events occurring during the year after myocardial infarction, were comparable across different dietary patterns. Patients with a combination of standard monitoring and APM after MI compared with only standard management with a protein-fat diet did not have emergency ischemic hospitalizations (p = 0.004), in particular due to unstable angina (p = 0.037), 2.2 times more likely to achieve target heart rate (p = 0.021); with the fruit-cereal stereotype, theywere 1.7 times more likely to report regular outpatient visits during the year of post-infarction observation (p = 0.002) and 2.5 times more likely to achieve the target heart rate (p = 0.005); with the milk-carbohydrate stereotype – they were 1.2 times more likely to adhere to taking beta blockers (p = 0.044), 2.9 times more likely to report regular outpatient visits during the year of post-infarction observation (p = 0.001), in addition, all these patients achieved target heart rate (p = 0.001); with a mixed stereotype, they reached the target blood pressure level 1.6 times more often (p = 0.021).   Conclusion. Regardless of the stereotype nutrition of the patient before myocardial infarction; optimization of standard observation by attaching an APM has undoubted advantages over isolated standard post-infarction ambulatory management throughout the year by reducing the frequency of hospitalizations for cardiovascular diseases judicial causes and the development of a combined ischemic endpoint.