title: The effectiveness of the cardiovascular disease prevention programme 'KardioPro' initiated by a German sickness fund: a time-to-event analysis of routine data.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of morbidity and mortality in the developed world. To reduce this burden of disease, a German sickness fund ('Siemens-Betriebskrankenkasse', SBK) initiated the prevention programme 'KardioPro' including primary (risk factor reduction) and secondary (screening) prevention and guideline-based treatment. The aim of this study was to assess the effectiveness of 'KardioPro' as it is implemented in the real world.
  
  
  METHODS
  The study is based on sickness fund routine data. The control group was selected from non-participants via propensity score matching. Study analysis was based on time-to-event analysis via Cox proportional hazards regression with the endpoint 'all-cause mortality, acute myocardial infarction (MI) and ischemic stroke (1)', 'all-cause mortality (2)' and 'non-fatal acute MI and ischemic stroke (3)'.
  
  
  RESULTS
  A total of 26,202 insurants were included, 13,101 participants and 13,101 control subjects. 'KardioPro' enrollment was associated with risk reductions of 23.5% (95% confidence interval (CI) 13.0-32.7%) (1), 41.7% (95% CI 30.2-51.2%) (2) and 3.5% (hazard ratio 0.965, 95% CI 0.811-1.148) (3). This corresponds to an absolute risk reduction of 0.29% (1), 0.31% (2) and 0.03% (3) per year.
  
  
  CONCLUSIONS
  The prevention programme initiated by a German statutory sickness fund appears to be effective with regard to all-cause mortality. The non-significant reduction in non-fatal events might result from a shift from fatal to non-fatal events.
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Witt
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany; Ludwig-Maximilians-Universität, Munich Center of Health Sciences, Munich, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Becker
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
authors.affiliation: Klinik Augustinum München, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Block
authors.affiliation: Klinikum Coburg, Coburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.affiliation: Herzzentrum an der Isar, Munich, Germany.
authors.forename: Sigmund
authors.initials: S
authors.lastname: Silber
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Stollenwerk
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D016022:Case-Control Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D011379:Prognosis; D015397:Program Evaluation; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors