title: Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines.
abstract: BACKGROUND
  Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years.
  
  
  METHODS
  The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes.
  
  
  RESULTS
  Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95% CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95% CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95% CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care.
  
  
  CONCLUSIONS
  This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.
authors.affiliation: Institute for Health Economics and Healthcare Management, Helmholtz Zentrum München, Neuherberg, Munich, Germany, r.stark@helmholtz-muenchen.de.
authors.forename: Renee
authors.initials: R
authors.lastname: Stark
authors.forename: Inge
authors.initials: I
authors.lastname: Kirchberger
authors.forename: Matthias
authors.initials: M
authors.lastname: Hunger
authors.forename: Margit
authors.initials: M
authors.lastname: Heier
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: von Scheidt
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
mesh_terms: D000368:Aged; D002309:Cardiology / Q000592:standards*; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome