Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data

Christian Fischer; Jens Höpner; Saskia Hartwig; Michel Noutsias; Rafael Mikolajczyk

doi:10.1186/s12872-020-01832-3

Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data

BMC Cardiovasc Disord. 2021 Jan 6;21(1):18. doi: 10.1186/s12872-020-01832-3.

Authors

Christian Fischer¹, Jens Höpner¹, Saskia Hartwig¹, Michel Noutsias², Rafael Mikolajczyk³

Affiliations

¹ Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
² Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany.
³ Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany. Rafael.mikolajczyk@uk-halle.de.

Abstract

Background: Cardiovascular diseases are still the main cause of death in the western world. However, diminishing mortality rates of acute myocardial infarction (AMI) are motivating the need to investigate the process of secondary prevention after AMI. Besides cardiac rehabilitation, disease management programs (DMPs) are an important component of outpatient care after AMI in Germany. This study aims to analyze outcomes after AMI among those who participated in DMPs and cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality.

Methods: Based on data from a regional myocardial infarction registry and a 2-year follow-up period, we assessed the occurrence of major adverse cardiac events (MACE) in relation to participation in CR and DMP, risk factors for complications and individual healths well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred.

Results: Of 1094 observed patients post-AMI, 272 were enrolled in a DMP. An association between DMP participation and lower hazard rates for MACE compared to non-enrollees could not be proven in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65-1.33). When adjusted for possible confounding variables, these results remained virtually unchanged (1.03; 0.72-1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, those who participated in CR showed a lower risk for MACE in crude (0.52; 0.41-0.65) and adjusted analysis (0.56; 0.44-0.71).

Conclusions: Participation in DMP was not associated with a lower risk of MACE, but participation in CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, but it is still important to consider potential effects of additional confounding variables.

Keywords: Coronary heart disease; DMP; Health care; Heart attack; MACE; Myocardial infarction; Outpatient; Rehabilitation; Secondary prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Ambulatory Care
Cardiac Rehabilitation*
Disease Management*
Female
Humans
Longitudinal Studies
Male
Middle Aged
Myocardial Infarction / diagnosis
Myocardial Infarction / mortality
Myocardial Infarction / physiopathology
Myocardial Infarction / rehabilitation*
Patient Participation*
Prospective Studies
Recurrence
Registries
Risk Assessment
Risk Factors
Secondary Prevention
Time Factors
Treatment Outcome