High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study

Abstract

We aimed to assess patient acceptance and effectiveness of a 12-month structured management program in patients after an acute coronary syndrome (ACS) event who were treated in a special setting of office-based cardiologists. The program comprised patient documentation with a specific tool (Bundesverband Niedergelassener Kardiologen [German Federation of Office-Based Cardiologists] cardiac pass with visit scheduling) shared by the hospital physician and the office-based cardiologist, the definition of individual treatment targets, and the systematic information of patients in order to optimize adherence to therapy. Participating centers (36 hospitals, 60 office-based cardiologists) included a total of 1,003 patients with ACS (ST-segment elevation myocardial infarction [STEMI] 44.3%, non-ST-segment elevation myocardial infarction [NSTEMI] 39.5%, unstable angina pectoris [UA] 15.2%, and unspecified 1.0%). During follow-up, treatment rates with cardiac medication remained high in all groups, with dual antiplatelet therapy in 91.0% at 3 months, 90.0% at 6 months, and 82.8% at 12 months, respectively. Twelve months after the inclusion, a total of 798 patients (79.6%) still participated in the program. Eighteen patients (1.8%) had died after discharge from hospital (6 in the STEMI, 12 in the NSTEMI group), while for 58 the status was unknown (5.8%). Based on a conservative approach that considered patients with unknown status as dead, 1-year mortality was 7.6%. Recurrent cardiac events were noted in 14.9% at 1 year, with an about equal distribution across STEMI and NSTEMI patients. In conclusion, patients’ acceptance of the ProAcor program as determined by adherence rates over time was high. Treatment rates of recommended medications used for patients with coronary heart disease were excellent. The 1-year mortality rate was comparatively low.

Keywords:

• myocardial infarction
• patient management
• patient education
• feedback
• patient-oriented outcomes
• therapy adherence
• compliance
• mortality
• quality of life

Acknowledgments

We thank the participating investigators and their staff (listed in the supplementary materials). Further, we acknowledge the statistical work by Dipl.-Math. Peter Klein, d.s.h. statistical services GmbH, Rohrbach, Germany. Project management for the study was supervised by Susanne Oldenburg and Simon Glück, BNK Service GmbH (Dienstleistungsunternehmen des Bundesverbandes Niedergelassener Kardiologen e.V.), Munich, Germany. Editorial support in generating this manuscript was provided by 3P Consulting, Seefeld, Germany. Results have been presented at the Scientific Sessions of the American Heart Association, November 10, 2015, Orlando, FL, USA.

Disclosure

This study was sponsored by AstraZeneca GmbH, Wedel, Germany. The authors report no other conflicts of interest in this work.