Effects of a nurse-based case management compared to usual care among aged patients with myocardial infarction: results from the randomized controlled KORINNA study

BMC Geriatrics

Rolf Holle²  Bernhard Kuch³  Rupert Wende¹  Hildegard Seidl²  Inge Kirchberger⁴  Björn Stollenwerk²  Christa Meisinger⁴ 

[1] Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany;Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany;Donau-Ries-Kliniken, Department for Internal Medicine/Cardiology, Nördlingen, Germany;KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany

关键词: Myocardial infarction;    Case management;    Randomized controlled trial;    Elderly;   

Others  :  856692
DOI  :  10.1186/1471-2318-13-115

 received in 2013-06-11, accepted in 2013-10-15,  发布年份 2013

【 摘 要 】

Background

Transition from hospital to home is a critical period for older persons with acute myocardial infarction (AMI). Home-based secondary prevention programs led by nurses have been proposed to facilitate the patients’ adjustment to AMI after discharge. The objective of this study was to evaluate the effects of a nurse-based case management for elderly patients discharged after an AMI from a tertiary care hospital.

Methods

In a single-centre randomized two-armed parallel group trial of patients aged 65 years and older hospitalized with an AMI between September 2008 and May 2010 in the Hospital of Augsburg, Germany, patients were randomly assigned to a case management or a control group receiving usual care. The case-management intervention consisted of a nurse-based follow-up for one year including home visits and telephone calls. Key elements of the intervention were to detect problems or risks and to give advice regarding a wide range of aspects of disease management (e.g. nutrition, medication). Primary study endpoint was time to first unplanned readmission or death. Block randomization per telephone call to a biostatistical center, where the randomization list was kept, was performed. Persons who assessed one-year outcomes and validated readmission data were blinded. Statistical analysis was based on the intention-to-treat approach and included Cox Proportional Hazards models.

Results

Three hundred forty patients were allocated to receive case-management (n=168) or usual care (n=172). The analysis is based on 329 patients (intervention group: n=161; control group: n=168). Of these, 62% were men, mean age was 75.4 years, and 47.1% had at least either diabetes or chronic heart failure as a major comorbidity. The mean follow-up time for the intervention group was 273.6 days, and for the control group it was 320.6 days. During one year, in the intervention group there were 57 first unplanned readmissions and 5 deaths, while the control group had 75 first unplanned readmissions and 3 deaths. With respect to the endpoint there was no significant effect of the case management program after one year (Hazard Ratio 1.01, 95% confidence interval 0.72-1.41). This was also the case among subgroups according to sex, diabetes, living alone, and comorbidities.

Conclusions

A nurse-based management among elderly patients with AMI had no significant influence on the rate of first unplanned readmissions or death during a one-year follow-up. A possible long-term influence should be investigated by further studies.

Clinical trial registration

ISRCTN02893746

【 授权许可】

   
2013 Meisinger et al.; licensee BioMed Central Ltd.

【 图 表 】

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