Key result
Participation in Disease Management Programs after acute myocardial infarction was not associated with a lower risk of major adverse cardiac events (adjusted HR 1.03), whereas cardiac rehabilitation reduced the risk (adjusted HR 0.56).
Why the study?
Diminishing mortality rates after acute myocardial infarction motivated the need to evaluate secondary prevention, specifically assessing outcomes among patients participating in disease management programs and stationary cardiac rehabilitation.
Does participation in Disease Management Programs or cardiac rehabilitation reduce major adverse cardiac events in patients after acute myocardial infarction?
Observational (n=1,094)
Yes
Does participation in Disease Management Programs or cardiac rehabilitation reduce major adverse cardiac events in patients after acute myocardial infarction?
Hazard Ratio: 1.03 (95% CI 0.72–1.48)
In patients surviving an acute myocardial infarction, participation in stationary cardiac rehabilitation, but not disease management programs, was associated with a significantly reduced risk of major adverse cardiac events at 2 years.
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 stationary and ambulatory 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 stationary cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: On the basis of data from a regional myocardial infarction registry and a 2-years 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 health, and lifestyle characteristics. Multivariable Cox regression was performed to compare survival time until an adverse event occurred. Results Out of 1,094 observed patients AMI, 272 were enrolled in a DMP. A weak association between DMP participation and hazard rates for MACE compared to non-enrollees was found in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65–1.33). When adjusted for possible confounders, this difference disappeared (1.03; 0.72–1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, participants of 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, while CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, still potential effects of confounding need to be considered.
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Fischer et al. (2020) conducted an observational in Acute Myocardial Infarction (n=1,094). Disease Management Programs (DMP) vs. Non-participation in DMP was evaluated on Survival time until the first major adverse cardiac event (MACE) (HR 1.03, 95% CI 0.72-1.48). Participation in Disease Management Programs after acute myocardial infarction was not associated with a lower risk of major adverse cardiac events (adjusted HR 1.03), whereas cardiac rehabilitation reduced the risk (adjusted HR 0.56).
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