Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany.
BMC Cardiovasc Disord. 2021 Jan 6;21(1):18. doi: 10.1186/s12872-020-01832-3.
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.
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.
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).
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.
心血管疾病仍然是西方世界的主要死亡原因。然而，急性心肌梗死（AMI）死亡率的下降促使人们需要研究 AMI 后的二级预防过程。除了心脏康复外，疾病管理计划（DMP）是德国 AMI 后门诊护理的重要组成部分。本研究旨在分析在心血管发病率和死亡率总体上升的地区，参与 DMP 和心脏康复（CR）的 AMI 患者的预后。
基于区域心肌梗死登记处和为期 2 年的随访数据，我们评估了主要不良心脏事件（MACE）的发生与参与 CR 和 DMP 的关系，并发症和个体健康的危险因素以及生活方式特征。多变量 Cox 回归用于比较参与者和非参与者在发生不良事件之前的生存时间。
在观察到的 1094 例 AMI 患者中，有 272 例参加了 DMP。在未调整模型中，与未参加者相比，DMP 参与者的 MACE 危险率较低，但未证明存在关联（危险比=0.93；95%置信区间=0.65-1.33）。当调整可能的混杂变量时，这些结果几乎没有变化（1.03；0.72-1.48）。此外，吸烟者和肥胖患者参加 DMP 的机会明显较低。相比之下，在未调整（0.52；0.41-0.65）和调整分析（0.56；0.44-0.71）中，参加 CR 的患者 MACE 的风险较低。
参加 DMP 与 MACE 的风险降低无关，但参加 CR 显示出有益的效果。在两种情况下，调整仅略微改变了效应估计值，但仍重要的是要考虑其他混杂变量的潜在影响。
