Participation in Disease Management Programs and Major Adverse Cardiac Events in Patients After Acute Myocardial Infarction.

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 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.