The RHESA-CARE study: an extended baseline survey of the regional myocardial infarction registry of Saxony-Anhalt (RHESA) design and objectives

Junge

Schmidt‐Pokrzywniak

et al. 2020

BMC Cardiovasc Disord

Self Cite

Background: Smoking cessation is one of the most effective secondary prevention measures after acute myocardial infarction (AMI). However, around 50% of smokers do not quit smoking after AMI. The aim of the present study is to estimate the proportion of patients quitting smoking and to identify determinants of persistent smoking after AMI in a region with increased cardiovascular mortality. We also assessed the time of smoking cessation after AMI. Methods: We used follow-up data of patients registered with the Regional Myocardial Infarction Registry in Saxony-Anhalt (RHESA) in Germany. We assessed smoking status and determinants of persistent smoking six weeks after discharge from hospital after AMI. Information on smoking, sociodemographic characteristics, risk factors for AMI, experienced symptoms of AMI, and clinical care were gathered in a computer-assisted telephone interview and questionnaires filled out by study subjects and physicians or study nurses. Results: Out of 372 smokers at the time of AMI, 191 (51.3%) reported that they quit smoking within six weeks after discharge from hospital after AMI. Strongest determinant of persistent smoking was a previous AMI before the current one (OR = 2.19, 95%CI 1.10-4.38) and strongest determinants of smoking cessation were experiencing complications in the hospital (0.37, 95%CI 0.12-1.12) and having a life partner (0.56, 95%CI 0.34-0.95). Most individuals who stopped smoking did so during the initial stay in the hospital, before the cardiac rehabilitation (CR). Conclusions: Persistent smoking after AMI and its determinants were similar in our region to previous studies. CR cannot be viewed as determinant of smoking cessationmore likely the same teachable moment induces behavioural change with regard to smoking and participation in CR.

Section: Methodsmentioning

confidence: 99%

Determinants of persistent smoking after acute myocardial infarction: an observational study

Junge

Schmidt‐Pokrzywniak

et al. 2020

BMC Cardiovasc Disord

Self Cite

“…We used data from follow-up of patients registered in RHESA. RHESA and its follow-up modalities were described elsewhere [27,28]. In brief, RHESA collected information about all fatal and non-fatal myocardial infarctions in the city of Halle and in the rural region of the Altmark in Saxony-Anhalt.…”

Section: Methods: Samplementioning

confidence: 99%

“…Patients who agreed to participate in RHESA are followed over time using questionnaires and health status information [28]. One explanation of the elevated mortality can be suboptimal secondary prevention.…”

mentioning

confidence: 99%

Participation in Disease Management Programs and Major Adverse Cardiac Events in Patients After Acute Myocardial Infarction.

Fischer

Hartwig

et al. 2020

Preprint

Background 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 stationary and ambulatory 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 stationary cardiac rehabilitation (CR) in a region with overall increased cardiovascular morbidity and mortality. Methods: On the basis of data from a regional myocardial infarction registry and a 2-years 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 health, and lifestyle characteristics. Multivariable Cox regression was performed to compare survival time until an adverse event occurred.Results Out of 1,094 observed patients AMI, 272 were enrolled in a DMP. A weak association between DMP participation and hazard rates for MACE compared to non-enrollees was found in the crude model (hazard ratio = 0.93; 95% confidence interval = 0.65–1.33). When adjusted for possible confounders, this difference disappeared (1.03; 0.72–1.48). Furthermore, smokers and obese patients showed a distinctly lower chance of DMP enrollment. In contrast, participants of CR showed a lower risk for MACE in crude (0.52; 0.41–0.65) and adjusted analysis (0.56; 0.44–0.71).Conclusions Participation in DMP was not associated with a lower risk of MACE, while CR showed beneficial effects. Adjustment only slightly changed effect estimates in both cases, still potential effects of confounding need to be considered.

“…We used data from follow-up of patients registered in RHESA. RHESA and its follow-up modalities were described elsewhere [27,28]. In brief, RHESA was established to investigate the causes of the increased level of morbidity and mortality of AMI of the federal state [27] and collected information about all fatal and non-fatal myocardial infarctions in the city of Halle and in the rural region of the Altmark.…”

Section: Study Design Study Location Period Of Recruitment and Participantsmentioning

confidence: 99%

“…In addition to collecting anonymous data, patients with AMI were asked during their hospital stay if they are willing to contribute their data and answer questionnaires in the future. Study instruments included hospital questionnaires lled out by medical staff, death certi cates of the regionally responsible health o ce and documentations of emergency aid [28]. The recruitment for RHESA and its baseline information was obtained via questionnaires from physicians or study nurses in the respective hospitals since June 2013 and is ongoing.…”

Section: Study Design Study Location Period Of Recruitment and Participantsmentioning

confidence: 99%

Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction. A longitudinal study based on registry data

Fischer

Hartwig

et al. 2020

Preprint

Background: 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. Methods: 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 healthas well as lifestyle characteristics. Multivariable Cox regression was performed to compare survival time between participants and non-participants until an adverse event occurred. Results: Of 1,094 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). Conclusions: 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 confounding variables.