Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data
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...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-020-01832-3 |
| _version_ | 1818562748026454016 |
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| author | Christian Fischer Jens Höpner Saskia Hartwig Michel Noutsias Rafael Mikolajczyk |
| author_facet | Christian Fischer Jens Höpner Saskia Hartwig Michel Noutsias Rafael Mikolajczyk |
| author_sort | Christian Fischer |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T01:07:49Z |
| format | Article |
| id | doaj.art-e42fc740bf604622a559b0047d917a0e |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-14T01:07:49Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-e42fc740bf604622a559b0047d917a0e2022-12-21T23:22:54ZengBMCBMC Cardiovascular Disorders1471-22612021-01-0121111110.1186/s12872-020-01832-3Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry dataChristian Fischer0Jens Höpner1Saskia Hartwig2Michel Noutsias3Rafael Mikolajczyk4Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-WittenbergInstitute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-WittenbergInstitute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-WittenbergMid-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-WittenbergInstitute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-WittenbergAbstract 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.https://doi.org/10.1186/s12872-020-01832-3Myocardial infarctionHeart attackDMPRehabilitationMACEOutpatient |
| spellingShingle | Christian Fischer Jens Höpner Saskia Hartwig Michel Noutsias Rafael Mikolajczyk Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data BMC Cardiovascular Disorders Myocardial infarction Heart attack DMP Rehabilitation MACE Outpatient |
| title | Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data |
| title_full | Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data |
| title_fullStr | Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data |
| title_full_unstemmed | Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data |
| title_short | Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data |
| title_sort | participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction a longitudinal study based on registry data |
| topic | Myocardial infarction Heart attack DMP Rehabilitation MACE Outpatient |
| url | https://doi.org/10.1186/s12872-020-01832-3 |
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