Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival

Abstract

Objective Acute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guidelinerecommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years. Methods The study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models. Results The propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and β-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757). Conclusion Previous and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.

The Impact of the COVID-19 Pandemic on Avoidance of Health Care, Symptom Severity, and Mental Well-Being in Patients With Coronary Artery Disease

“…Percentages, means, and standard deviations for sample characteristics can be found in Table 2. The characteristics of our CAD patients are similar to the DMP-CAD patient sample in a recent German study (20). In their study, CAD patients were mostly male (66.9%), often had comorbidities such as diabetes mellitus type 2 (41.7%), and showed a similar age distribution with a mean age of 73.7 years.…”

“…Similarly to a recent study (54), our results indicate that there might be a considerable prevalence of primary care CAD patients who are not optimally controlled. Although the DMP-CAD enrollment significantly reduces patients' mortality and improves medication adherence and adjustment (19)(20)(21), our results suggest potential for improvements and highlight the need for better communication strategies between patient and physician.…”

“…In contrast, across Europe, four times as many patients with chronic diseases reported visiting their doctor less frequently ( 44 ), indicating a comparable mild effect of the pandemic on CAD patients' health care in our sample from Central Germany. There might be two potential reasons for this effect: on the one hand, the high compliance of CAD patients during the pandemic might be attributable to the DMP enrollment, which has previously been found to improve CAD patients' adherence to medication, frequency of medical care, and disease-related knowledge and awareness ( 20 , 21 , 45 , 46 ). On the other hand, Central Germany was less affected by the pandemic compared to other European countries, which potentially caused less changes in patients' health behavior ( 47 ).…”

“…The DMP includes regular quarterly or biannually consultations with the patient's general practitioner (GP) to adjust medication, discuss disease related lifestyle issues to reduce risk factors, and monitor the progression of the CAD (19). CAD patients enrolled in the DMP have a significantly lower risk of death, better adjustment of and adherence to medication, and received more counseling on health behavior (19)(20)(21). However, to reduce the risk of infection with COVID-19 in high-risk populations, the Federal Joint Committee decided in March 2020 that interventions in the DMPs could have been suspended or canceled (22).…”

Passive Prescription of Secondary Prevention Medical Therapy During Index Hospitalization for Acute Myocardial Infarction is Prevalent and Associated with Adverse Clinical Outcomes

“…AMI has become one of the most common causes for hospital admission and is associated with signi cant risk of mortality and morbidity in the world [1], especially in China [2]. Despite that guideline recommendations are well-established, many AMI patients still do not receive optimal care resulting in suboptimal clinical outcomes [3][4][5]. Multiple studies have been performed to explore the factors associated with non-adherence in order to improve quality of care.…”