Skip to main content

Advertisement

SpringerLink
Log in

Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References:

  1. Federal Ministry of Health Mortality statistics. Available from URL: www.gbe-bund.de/gbe10/F?F=14187D. Accessed on 01.08.2012

  2. WHO (2012) Global atlas on cardiovascular disease prevention and control available on http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/index.html. Accessed 08.07.2013

  3. Smith SC Jr, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA (2006) AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 113(19):2363–2372. doi:10.1161/CIRCULATIONAHA.106.174516

    Article  PubMed  Google Scholar 

  4. Federal Insurance Agency Basic facts of disease management programs in Germany, http://www.bundesversicherungsamt.de/cln_115/nn_1046154/DE/DMP/dmp__inhalt.html. Accessed 2 Aug 2012

  5. Federal Joint Committee Directives regarding disease management programs in Germany, http://www.g-ba.de/downloads/62-492-353/2009-07-01-RSAV20.pdf (see page 1552 regarding CHD-DMP). Accessed November 6, 2012 2012

  6. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F, European Association for Cardiovascular P, Rehabilitation, Guidelines ESCCfP (2012) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth joint task force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 33(13):1635–1701. doi:10.1093/eurheartj/ehs092

    Article  CAS  PubMed  Google Scholar 

  7. Zeymer U, Junger C, Zahn R, Bauer T, Bestehorn K, Senges J, Gitt A (2011) Effects of a secondary prevention combination therapy with an aspirin, an ACE inhibitor and a statin on 1-year mortality of patients with acute myocardial infarction treated with a beta-blocker. Support for a polypill approach. Curr Med Res Opin 27(8):1563–1570. doi:10.1185/03007995.2011.590969

    Article  CAS  PubMed  Google Scholar 

  8. Federal Statistics Office Annual German Population on December 31st of each year, www.gbe-bund.de/gbe10/F?F=262D. Accessed 2 Aug 2012

  9. Federal Statistics Office Prevalence of coronary heart disease diagnosed by a physician based on patient reports, www.gbe-bund.de/gbe10/F?F=204D Accessed 2 Aug 2012

  10. Miksch A, Laux G, Ose D, Joos S, Campbell S, Riens B, Szecsenyi J (2010) Is there a survival benefit within a German primary care-based disease management program? Am J Manag Care 16(1):49–54. doi:12562

    PubMed  Google Scholar 

  11. Drabik A, Buscher G, Thomas K, Graf C, Muller D, Stock S (2012) Patients with type 2 diabetes benefit from primary care-based disease management: a propensity score matched survival time analysis. Popul Health Manag 15(4):241–247. doi:10.1089/pop.2011.0063

    Article  PubMed  Google Scholar 

  12. Gapp O, Schweikert B, Meisinger C, Holle R (2008) Disease management programmes for patients with coronary heart disease—an empirical study of German programmes. Health Policy 88(2–3):176–185. doi:10.1016/j.healthpol.2008.03.009

    Article  PubMed  Google Scholar 

  13. Holle R, Happich M, Lowel H, Wichmann HE, Group MKS (2005) KORA—a research platform for population based health research. Gesundheitswesen 67(Suppl 1):S19–S25. doi:10.1055/s-2005-858235

    Article  PubMed  Google Scholar 

  14. Kirchberger I, Heier M, Kuch B, Wende R, Meisinger C (2011) Sex differences in patient-reported symptoms associated with myocardial infarction (from the population-based MONICA/KORA Myocardial Infarction Registry). Am J Cardiol 107(11):1585–1589. doi:10.1016/j.amjcard.2011.01.040

    Article  PubMed  Google Scholar 

  15. Hostetter JC, Ghaffari S (2003) Should everyone with a recent myocardial infarction receive a beta-blocker and an ACE inhibitor? Clevel Clin J Med 70(1):46–48

    Article  Google Scholar 

  16. Leidl R, Reitmeir P (2011) A value set for the EQ-5D based on experienced health states: development and testing for the German population. Pharmacoeconomics 29(6):521–534. doi:10.2165/11538380-000000000-00000

    Article  PubMed  Google Scholar 

  17. Horton NJ, Lipsitz SR (2001) Multiple imputation in practice: comparison of software packages for regression models with missing variables. Am Stat 55(3):244–254

    Article  Google Scholar 

  18. Schunk M, Stark R, Reitmeir P, Rathmann W, Meisinger C, Holle R (2011) Improvements in type 2 diabetes care? Pooled analysis of survey data in southern Germany (KORA) from 1999-2008. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 54(11):1187–1196. doi:10.1007/s00103-011-1364-4

    Article  CAS  PubMed  Google Scholar 

  19. Stark RG, Schunk MV, Meisinger C, Rathmann W, Leidl R, Holle R, Grp KS (2011) Medical care of type 2 diabetes in German disease management programmes: a population-based evaluation. Diabetes Metab Res 27(4):383–391

    Article  Google Scholar 

  20. Jolly K, Bradley F, Sharp S, Smith H, Thompson S, Kinmonth AL, Mant D (1999) Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP). The SHIP Collaborative Group. BMJ 318(7185):706–711

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Khunti K, Stone M, Paul S, Baines J, Gisborne L, Farooqi A, Luan X, Squire I (2007) Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial. Heart 93(11):1398–1405. doi:10.1136/hrt.2006.106955

    Article  PubMed Central  PubMed  Google Scholar 

  22. Law MR, Watt HC, Wald NJ (2002) The underlying risk of death after myocardial infarction in the absence of treatment. Arch Intern Med 162(21):2405–2410

    Article  PubMed  Google Scholar 

  23. Kuch B, Heier M, von Scheidt W, Kling B, Hoermann A, Meisinger C (2008) 20-year trends in clinical characteristics, therapy and short-term prognosis in acute myocardial infarction according to presenting electrocardiogram: the MONICA/KORA AMI Registry (1985-2004). J Intern Med 264(3):254–264. doi:10.1111/j.1365-2796.2008.01956.x

    Article  CAS  PubMed  Google Scholar 

  24. McAlister FA, Lawson FM, Teo KK, Armstrong PW (2001) Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. BMJ 323(7319):957–962

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Murphy AW, Cupples ME, Smith SM, Byrne M, Byrne MC, Newell J (2009) Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice: cluster randomised controlled trial. BMJ 339:b4220. doi:10.1136/bmj.b4220

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Bailey TC, Noirot LA, Gage BF, Li X, Shannon WD, Waterman B, Sinha S, Bouselli DA, Reichley RM, Goldberg AC, Dunagan WC (2006) Improving adherence to coronary heart disease secondary prevention medication guidelines at a community hospital. AMIA Annual Symposium proceedings/AMIA Symposium AMIA Symposium:850

  27. Tickoo S, Fonarow GC, Hernandez AF, Liang L, Cannon CP (2008) Weekend/holiday versus weekday hospital discharge and guideline adherence (from the American Heart Association’s get with the guidelines—coronary artery disease database). Am J Cardiol 102(6):663–667. doi:10.1016/j.amjcard.2008.04.053

    Article  PubMed  Google Scholar 

  28. Ctt C Cholesterol Treatment Trialists’ (2012) The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. doi:10.1016/S0140-6736(12)60367-5

    Google Scholar 

  29. Law MR, Morris JK, Wald NJ (2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338:b1665. doi:10.1136/bmj.b1665

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Antithrombotic Trialists C, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373(9678):1849–1860. doi:10.1016/S0140-6736(09)60503-1

    Article  Google Scholar 

  31. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, Gomez-Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pinto X, Basora J, Munoz MA, Sorli JV, Martinez JA, Martinez-Gonzalez MA, Investigators PS (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368(14):1279–1290. doi:10.1056/NEJMoa1200303

    Article  CAS  PubMed  Google Scholar 

  32. Danaei G, Tavakkoli M, Hernan MA (2012) Bias in observational studies of prevalent users: lessons for comparative effectiveness research from a meta-analysis of statins. Am J Epidemiol 175(4):250–262. doi:10.1093/aje/kwr301

    Article  PubMed Central  PubMed  Google Scholar 

  33. Joos S, Rosemann T, Heiderhoff M, Wensing M, Ludt S, Gensichen J, Kaufmann-Kolle P, Szecsenyi J (2005) ELSID-Diabetes study-evaluation of a large scale implementation of disease management programmes for patients with type 2 diabetes. Rationale, design and conduct—a study protocol [ISRCTN08471887]. BMC Public Health 5:99. doi:10.1186/1471-2458-5-99

    Article  PubMed Central  PubMed  Google Scholar 

  34. Azaouagh A, Churzidse S, Konorza T, Erbel R (2011) Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a review and update. Clinical Res Cardiol Off J Ger Cardiac Soc 100(5):383–394. doi:10.1007/s00392-011-0295-2

    Article  CAS  Google Scholar 

  35. Dabiri Abkenari L, Theuns DA, Valk SD, Van Belle Y, de Groot NM, Haitsma D, Muskens-Heemskerk A, Szili-Torok T, Jordaens L (2011) Clinical experience with a novel subcutaneous implantable defibrillator system in a single center. Clin Res Cardiol Off J Ger Cardiac Soc 100(9):737–744. doi:10.1007/s00392-011-0303-6

    Article  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Institute for Health Economics and Healthcare Management, Helmholtz Zentrum München, Neuherberg, Munich, Germany

    Renee Stark, Matthias Hunger, Reiner Leidl & Rolf Holle

  2. Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Munich, Germany

    Inge Kirchberger, Margit Heier & Christa Meisinger

  3. Department of Health Economics and Health Care Management, Munich School of Management, University of Munich, Munich, Germany

    Reiner Leidl

  4. Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany

    Wolfgang von Scheidt

Authors
  1. Renee Stark
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inge Kirchberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Hunger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Margit Heier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reiner Leidl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolfgang von Scheidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christa Meisinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rolf Holle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renee Stark.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stark, R., Kirchberger, I., Hunger, M. et al. Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines. Clin Res Cardiol 103, 237–245 (2014). https://doi.org/10.1007/s00392-013-0643-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-013-0643-5

Keywords

Search

Navigation