Key result
Participation in disease management programs after acute myocardial infarction was not associated with a lower risk of major adverse cardiac events (HR 1.03), whereas participation in cardiac rehabilitation showed beneficial effects (HR 0.56).
Why the study?
Diminishing mortality rates after AMI motivate investigating secondary prevention, including outcomes associated with disease management programs and cardiac rehabilitation in a region with increased cardiovascular morbidity and mortality.
Does participation in disease management programs or cardiac rehabilitation reduce major adverse cardiac events in patients after acute myocardial infarction?
Cohort (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)
Cardiac rehabilitation, but not disease management programs, is associated with a significantly reduced risk of major adverse cardiac events following acute myocardial infarction, though self-selection bias may partially explain this benefit.
CR but not DMP participation was associated with lower post-AMI MACE risk; leaves open causality and requires randomized confirmation.
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.
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Fischer et al. (2021) conducted a cohort in Acute myocardial infarction (n=1,094). Disease management programs (DMP) vs. Non-participants was evaluated on Major adverse cardiac events (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 (HR 1.03), whereas participation in cardiac rehabilitation showed beneficial effects (HR 0.56).
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