Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines
Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years.
The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes.
Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95 % CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95 % CI 0.64–1.27). Guideline-care significantly improved survival (HR 0.41, 95 % CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care.
This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.
KeywordsDisease management Coronary disease Secondary prevention
The KORA research platform (KORA, Cooperative Research in the Region of Augsburg) was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria. The survival analysis was part of the project “Medium term effects of Disease Management Programs for Coronary Heart Disease” funded by the Federal Association of Statutory Regional Health Funds (AOK Bundesverband). We thank all members of the Helmholtz Zentrum München who are involved in the conduct of the study. Furthermore, we wish to thank the field staff in Augsburg, especially Claudia Greschik, Dorothea Lukitsch, and Gisela Sietas.
Conflict of interest
The authors declare that they have no conflict of interest.
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