Construction And Evaluation Of Stratified Follow-up Pathway In Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervetion

ObjectiveTo construct a stratified follow-up pathway for patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),and then explore the effect of stratified follow-up pathway in the follow-up of AMI patients,so as to provide standardized follow-up management for patients with different risk levels.Methods1.After reading literature and working together by the research group,preliminary stratified follow-up pathway for AMI patients was developed.15 experts joined the Delphi consultation,according to their opinions,the stratified follow-up pathway was finally determined.2.From November 2018 to June 2019,100 patients with AMI who were admitted to a hospital for emergency PCI were selected.Routine follow-up was used by the control group;the experimental group was followed up by stratified follow-up pathway.After 6-month intervention,adverse cardiovascular events,readmission rate and laboratory indicators of the two groups were counted;their self-management and self-efficacy were estimated three times before,3 and 6 months after follow-up.Results1.15 experts joined two rounds of Delphi consultation.All the questionnaires in the two rounds were recovered,and the percentages of experts’ opinions were 66.7% and 20.0%,respectively.The expert’s judgment basis for the items was 0.910;the familiarity with the items was 0.800,so the authority coefficient reached 0.855.2.Firstly,the Kendall’s coefficients of the first level items,the second level items of low-risk patients and the second level items of high-risk patients were 0.274,0.220 and 0.279,respectively.In the next consultation,Kendall’s coefficients of the first level items,the second level items of low-risk patients and the second level items of high-risk patients were 0.436,0.340 and 0.313,respectively.3.In the first round,the average importance score of each item was from 3.867 to 4.867,and the variation coefficient was between 0.070 and 0.186.In the next round,the average importance score of each item was between 3.933 and 4.933,and the variation coefficient was from 0.051 to 0.161.4.The incidence of adverse cardiovascular events and readmission rate in the control group were 33.3% and 31.1%,respectively,while those in the experimental group were only 15.2% and 13.0%,respectively(P<0.05).5.After adjusting the concentration of blood glucose and blood lipids before the intervention,the triglyceride,cholesterol and LDL in the stratified follow-up group were lower compared with the control group(P<0.05).The difference of blood glucose between two groups was meaningless(P>0.05).6.The self-management ability and self-efficacy of the two groups were improved with the time of intervention.The self-management ability and self-efficacy of the experimental group were higher at different measurement times(P<0.05).Conclusions1.The stratified follow-up pathway is scientific and reliable,which provides a theoretical basis for the standardized follow-up of AMI patients.2.The implementation of stratified follow-up pathway can reduce the incidence of adverse cardiovascular events and readmission rate,promoting the recovery of the disease.3.The implementation of stratified follow-up pathway can reduce triglyceride,LDL and cholesterol,improving the control level of risk factors.4.The implementation of stratified follow-up pathway can improve the patients’ self-management ability and self-efficacy,enhancing the confidence of disease recovery,and promoting patients to adhere to long-term treatment.