Key result
Low physician continuity post-ACS is linked to ~2.2-fold higher all-cause mortality.
Why the study?
Postdischarge continuity of care after ACS remains suboptimal despite available GDMT, and evidence regarding its association with clinical outcomes in Asian health-care systems was limited.
Is lower postdischarge continuity of care (physician, specialty, and GDMT) associated with increased risks of mortality, MACEs, heart failure hospitalization, and major bleeding in patients with acute coronary syndrome?
Cohort (n=140,214)
Yes
Is lower postdischarge continuity of care (physician, specialty, and GDMT) associated with increased risks of mortality, MACEs, heart failure hospitalization, and major bleeding in patients with acute coronary syndrome?
In a large nationwide Taiwanese cohort of over 140,000 ACS survivors, lower postdischarge physician, specialty, and GDMT continuity of care during the first year was strongly associated with elevated risks of mortality and major cardiovascular events.
Answers are grounded in this paper and cite their sources.
Supports continuity-focused interventions post-ACS; leaves open whether improving continuity reduces mortality in randomized trials.
BACKGROUND: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Despite the availability of guideline-directed medical therapy (GDMT), postdischarge continuity of care (CoC) remains suboptimal, and evidence from Asian health-care systems remains limited. The present study examined the association between CoC and clinical outcomes in Taiwanese patients with ACS. METHODS: This nationwide observational cohort study was conducted using data from Taiwan's National Health Insurance Research Database. It included patients who had their first ACS-related hospitalization between 2012 and 2020 and excluded those who died during the index hospitalization or experienced study outcomes within 1 month after discharge. CoC was assessed in terms of physician, specialty, and GDMT continuity. Study outcomes were all-cause mortality, major adverse cardiovascular events (MACEs), hospitalization for heart failure (HHF), and major bleeding. RESULTS: This study included 140 214 patients with ACS. Patients with low physician continuity had significantly higher risks of all-cause mortality (adjusted risk ratio [aRR]: 2.20, 95% confidence interval [CI] 2.09 to 2.31), cardiovascular death (aRR: 1.97, 95% CI: 1.81 to 2.15), MACEs (aRR: 1.78, 95% CI: 1.66 to 1.90), HHF (aRR: 1.66, 95% CI: 1.54 to 1.78), and major bleeding (aRR: 1.45, 95% CI: 1.26 to 1.66) than did those with high physician continuity. Low specialty continuity was associated with a 1.28-to-1.95-fold increase in the risk of adverse outcomes. Furthermore, low GDMT continuity was significantly associated with elevated risks of all-cause mortality, cardiovascular death, and MACEs but not HHF or major bleeding. CONCLUSION: The findings suggest that lower CoC during the first year after ACS-related hospitalization is associated with poorer clinical outcomes. Future studies should explore strategies to improve CoC.
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Lin et al. (2026) conducted a cohort in Acute coronary syndrome (ACS) (n=140,214). Low postdischarge continuity of care (physician, specialty, and GDMT continuity) vs. High postdischarge continuity of care was evaluated on All-cause mortality (aRR 2.20, 95% CI 2.09-2.31). Low physician continuity of care post-ACS was associated with a higher risk of all-cause mortality (aRR 2.20; 95% CI 2.09-2.31) and MACEs (aRR 1.78; 95% CI 1.66-1.90) vs high continuity.
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