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

Figures & data

Figure 1 Study flow.

Abbreviations: BNK, Bundesverband Niedergelassener Kardiologen (German Federation of Office-Based Cardiologists); QoL, quality of life.

Table 1 Patient satisfaction with the managed care program investigated by ProAcor

	STEMI (N=364)	NSTEMI (N=319)	UA (N=117)	Total (N=800)
	N (%)	N (%)	N (%)	N (%)
Do you feel sufficiently informed on the reasons for your disease?
Yes	355 (97.5)	304 (95.3)	111 (94.9)	770 (96.3)
Do you need further information on the cause of your disease?
Yes	80 (22.0)	60 (18.8)	26 (22.2)	166 (20.8)
If Yes, how different should this information be?
More suitable for daily use	26 (32.5)	17 (28.3)	11 (42.3)	54 (32.5)
More pictures	2 (2.5)	2 (3.3)	1 (3.8)	5 (3.0)
Easier	21 (26.3)	20 (33.3)	4 (15.4)	45 (27.1)
per Internet	7 (8.8)	3 (5.0)	4 (15.4)	14 (8.4)
per Mail	4 (5.0)	5 (8.3)	1 (3.8)	10 (6.0)
More detailed	16 (20.0)	9 (15.0)	3 (11.5)	28 (16.9)
Do you feel sufficiently informed on the possibility of treating your disease via change of lifestyle?
Yes	346 (95.1)	302 (94.7)	109 (93.2)	757 (94.6)
Do you wish further information on lifestyle changes?
Yes	64 (17.6)	52 (16.3)	29 (24.8)	145 (18.1)
If Yes, how different should this information be?
Other/unspecified	2 (3.1)	0 (0.0)	2 (6.9)	4 (2.8)
Coaching	4 (6.3)	4 (7.7)	3 (10.3)	11 (7.6)
Easier	17 (26.6)	17 (32.7)	11 (37.9)	45 (31.0)
Convenient	6 (9.4)	7 (13.5)	4 (13.8)	17 (11.7)
Group initiatives
More detailed	9 (14.1)	7 (13.5)	1 (3.4)	17 (11.7)
To listen to	1 (1.6)	0 (0.0)	0 (0.0)	1 (0.7)
To read	25 (39.1)	17 (32.7)	8 (27.6)	50 (34.5)

Notes: Values are n (%), if not specified otherwise; 800 of the 1103 patients filled in the questionnaire on patient satisfaction.

Abbreviations: STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina.

Table 2 Collected patient parameters at baseline, follow-ups, and at the final examination

Visit	Baselinea	Follow-Up			Final
	1	Q1	Q2	Q3	Q4
Time (months)	0	3	6	9	12
Date of visit	x	x	x	x	x
Informed Consent	x
Inclusion/exclusion criteria	x
Distribution of information brochure/cards	x
Hand out/update of BNK Herzpass^®	x	x	x		x
Arrange a follow-up visit at the BNK cardiologist (optional)	x
Fax for the index documentation	x
Last echocardiography findings	x
Last vital values (blood pressure, heart rate, dyspnea)	x
Last laboratory values (troponin, potassium, creatinine, glucose, total/HDL/LDL cholesterol, lipoproteins, triglycerides, HbA1c)	x
Demographic data (date of birth, sex)		xb
Patient history including CV risk assessment (smoking status, hyperlipoproteinemia, diabetes, hypertension, CHD family history)		xb
Date of ACS diagnosis and type of ACS		xb
ACS index event-related procedures (interventions and medications)		xb
Concomitant medication (identical/different from row above)		x	x		x
Concomitant diseases		x	x		x
Physical/cardiological routine examination		x	x		x
New cardiac eventsc		x	x		x
Assessment of individual treatment goals/lifestyle changes		x	x		x
Distribution of patient information cardsd		x	x	xe	x
Pharmacoeconomic data (resource use in total; resource used by new cardiovascular event; primary care visits; visits to noncardiology specialists; other care – rehabilitation, etc.; inability to work)
Quality of life, general questions on satisfaction with program		x	x		x

Notes:

a Procedures performed at the hospital.

b Source data for this information was hospital discharge letter (index event).

c Any new episode of the ACS, stroke, CV procedure, hospitalization or death.

d Patient information cards were handed out intuitively according to patients’ situation (eg, only current smoker should receive information on smoking cessation).

e Patient information cards were sent out by the investigator, or BNK Service GmbH if desired by the investigator.

Abbreviations: BNK, Bundesverband Niedergelassener Kardiologen; HDL, High-density lipoprotein; LDL, Low-density lipoprotein; CV, Cardiovascular; CHD, coronary heart disease; ACS, acute coronary syndrome.

Table 3 Demographic characteristics of patients, comorbidities, and interventions after the index ACS event

	STEMI (n=407)	NSTEMI (n=347)	UA (n=133)	Total (n=887)
Demographics
Age (years ± SD)	58.9±11.2	64.0±12.0	64.3±10.9	61.7±11.6
Sex, males	312 (76.7)	237 (68.3)	104 (78.2)	653 (73.6)
Comorbidities
Arterial hypertension	271 (66.6)	273 (78.7)	100 (75.2)	644 (72.6)
Diabetes mellitus	78 (19.2)	78 (22.5)	41 (30.8)	197 (22.2)
Hyperlipoproteinemia	235 (57.7)	206 (59.4)	84 (63.2)	525 (59.2)
Peripheral arterial occlusive disease	15 (3.7)	23 (6.6)	10 (7.5)	48 (5.4)
Renal insufficiency	22 (5.4)	34 (9.8)	8 (6.0)	64 (7.2)
Family history of CHD	161 (39.6)	106 (30.5)	43 (32.3)	310 (34.9)
Prior stroke	9 (2.2)	14 (4.0)	7 (5.3)	30 (3.4)
Prior TIA/PRIND	1 (0.2)	5 (1.4)	3 (2.3)	9 (1.0)
Prior cardiac event	37 (9.1)	57 (16.4)	42 (31.6)	136 (15.3)
Interventions in hospital
PTCA	398 (97.8)	318 (91.6)	112 (84.2)	828 (93.3)
Stent	392 (98.5)	305 (95.9)	104 (92.9)	801 (90.3)
Drug eluting stent	265 (67.7)	221 (72.5)	70 (67.3)	556 (62.7)
Bare metal stent	70 (17.9)	59 (19.3)	24 (23.1)	153 (17.2)
Coronary artery bypass surgery	3 (0.7)	10 (2.9)	4 (3.0)	17 (1.9)

Notes: Values are n (%), if not specified otherwise.

Abbreviations: STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina; CHD, coronary heart disease; PTCA, percutaneous transluminal coronary angioplasty; SD, standard deviation; TIA, transient ischemic attack; PRIND, prolonged ischemic neurological deficit.

Figure 2 Antiplatelet therapy.

Notes: Values show the prescription rates (%) of the named drug classses or drugs in the total cohort, and in the STEMI, NSTEMI and UA subgroups.
Abbreviations: DAPT, dual antiplatelet therapy; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina.

Figure 3 Cardiac medication other than antiplatelets during the course of the observation.

Abbreviations: STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina; RAAS, renin angiotensin aldosterone system; ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker.

Figure 4 Death, unknown vital status, and cardiac events.

Abbreviations: STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina.