title: Effects of a 3-year nurse-based case management in aged patients with acute myocardial infarction on rehospitalisation, mortality, risk factors, physical functioning and mental health. a secondary analysis of the randomized controlled KORINNA study.
abstract: BACKGROUND
  Home-based secondary prevention programs led by nurses have been proposed to facilitate patients' adjustment to acute myocardial infarction (AMI). The objective of this study was to conduct secondary analyses of the three-year follow-up of a nurse-based case management for elderly patients discharged from hospital after an AMI.
  
  
  METHODS
  In a single-centre randomized two-armed parallel group trial of hospitalized patients with AMI ≥65 years, patients hospitalized between September 2008 and May 2010 in the Hospital of Augsburg, Germany, were randomly assigned to case management or usual care. The case-management intervention consisted of a nurse-based follow-up for three years including home visits and telephone calls. Study endpoints were time to first unplanned readmission or death, clinical parameters, functional status, depressive symptoms and malnutrition risk. Persons who assessed three-year outcomes and validated readmission data were blinded. The intention-to-treat approach was applied to the statistical analyses which included Cox Proportional Hazards models.
  
  
  RESULTS
  Three hundred forty patients were allocated to receive case-management (n = 168) or usual care (n = 172). During three years, in the intervention group there were 80 first unplanned readmissions and 6 deaths, while the control group had 111first unplanned readmissions and 3 deaths. The intervention did not significantly affect time to first unplanned readmission or death (Hazard Ratio 0.89, 95% confidence interval (CI) 0.67-1.19; p = 0.439), blood pressure, cholesterol level, instrumental activities of daily life (IADL) (only for men), and depressive symptoms. However, patients in the intervention group had a significantly better functional status, as assessed by the HAQ Disability Index, IADL (only for women), and hand grip strength, and better SCREEN-II malnutrition risk scores than patients in the control group.
  
  
  CONCLUSIONS
  A nurse-based management among elderly patients with AMI did not significantly affect time to unplanned readmissions or death during a three-year follow-up. However, the results indicate that functional status and malnutrition risk can be improved.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN02893746.
authors: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.
authors: Inge
authors: I
authors: Kirchberger
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors: Matthias
authors: M
authors: Hunger
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors: Björn
authors: B
authors: Stollenwerk
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors: Hildegard
authors: H
authors: Seidl
authors: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.
authors: Katrin
authors: K
authors: Burkhardt
authors: Department of Internal Medicine I-Cardiology, Central Hospital of Augsburg, Augsburg, Germany; Department for Internal Medicine/Cardiology, Donau-Ries-Kliniken, Nördlingen, Germany.
authors: Bernhard
authors: B
authors: Kuch
authors: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.
authors: Christa
authors: C
authors: Meisinger
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors: Rolf
authors: R
authors: Holle
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006792:House Calls; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008603:Mental Health; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology* / Q000534:rehabilitation; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012307:Risk Factors