Evaluation of survival of patients enrolled in disease management programs for cardiovascular disease compared to those receiving usual care

Aims: In 2006, medical care of patients enrolled in disease management programs (DMPs) for cardiovascular disease (CVD) was found to be better than that of patients receiving usual care. The present study aims to investigate if these differences in care have an effect on survival. Methods: In 2006, patients with a history of a myocardial infarction (MI) who had been registered by the KORA Myocardial-Infarction-Registry in Augsburg reported aspects of their medical care in a postal questionnaire. Their DMP enrolment status was verified by the treating physician. In 2011, survival of these patients was evaluated by an address search, repeat patient questionnaire and physician verification. Differences in survival between the CVD-DMP participants and controls were analysed with Cox regression analyses adjusting for confounders (age, sex, smoking, education, time since last MI, presence of diabetes). Variables were deemed significant if p<0.05. Results: 1026 patients were available for analysis, 591 were enrolled in the CVD-DMP and 435 were not (controls). Groups differed significantly regarding time since last infarction. Age, sex, smoking and presence of diabetes was similar between the groups. Mortality until end of 2010 was 14%. Survival analysis showed a significant advantage for DMP participants. Other significant factors affecting survival were age, sex and diabetes. Conclusions: Four year follow-up shows that CVD-DMP has a significant effect on survival, even after adjustment for obvious confounders. However, selection bias for DMP enrolment can not be excluded.

Literatur: Gapp, O., Schweikert, B., Meisinger, C., Holle, R.: Disease Management Programmes for Patients with Coronary Heart Disease – An Empirical Study of German Programmes. Health Policy 88, 176-85 (2008)

coronary heart disease - disease management program - survival