Background. In recent years, the treatment of STEMI has made significant progress which has led to an increase in survival and age of patients who have become chronic heart disease. Management is a major problem especially in the post-acute and chronic phases, previously considered stable. Post-hospital morbidity and mortality are increased particularly in patients with high residual risk.
Methods. The purpose of this work is to evaluate adherence to patient care pathways after STEMI in FVG from 2018 to 2021. This evaluation must take into account the restrictive measures adopted since March 2020 to contain the COVID 19 pandemic. The data was collected by the Regional Health Agency (ARCS) thanks to the launch of the Heart Network and the regional Diagnostic Therapeutic Plans (PDTA). The indicators of care pathways were: cholesterol-lowering prescription at 30 days; antiplatelet prescription after 30 days; beta-blocker prescription after 30 days; cardiological visit 2 months after discharge; persistence of statin therapy 1 year after discharge; LDL dosage 1 year after discharge; target LDL 1 year after discharge; nursing counseling 1 year after discharge.
Results. Patients with STEMI in FVG in 2018 were 830, in 2019 were 834, in 2020 were 772 and in 2021 were 782. The populations do not differ significantly in terms of age and gender (with a predominance of males). Observing the data on the management of patients in the post-acute phase there are no significant differences between the populations. However, if we analyze the data indicative of the management of patients in the chronic phase, the results differ in the populations. The persistence of statin therapy at 1 year is 82.8% in 2018 and it is 80.4% in 2019 while it is 69.7% in 2020 and 62.2% in 2021. Nursing counseling at 1 year is 60.8% in 2018, 62.5% in2019 while it is 37% in 2020 and 51.9% in 2021.
Conclusions. The COVID 19 pandemic has impacted the post-STEMI patient care process in FVG not so much in the post-acute phase but in the chronic phase. According to international guidelines, Cardiology Rehabilitation (CR) is strongly recommended in STEMI. No treatment in heart disease has stronger scientific evidence or a significantly greater impact on survival. Despite this, the CR facilities in FVG have not been strengthened in recent years, on the contrary they have suffered more significantly from the COVID-related restrictions and the depletion of resources.