Intensified ambulatory cardiology care: effects on mortality and hospitalisation\u2014a comparative observational study

Olga A Sawicki,Felix S Wicke,Anastasiya Glushan,Thorben Breitkreuz,Ferdinand M Gerlach,Norbert Smetak,Kateryna Karimova,Angelina Mueller,Martin Beyer,Ralph F Bosch,Michel Wensing

doi:10.1038/s41598-020-71770-9

Abstract

Since 2010, an intensified ambulatory cardiology care programme has been implemented in southern Germany. To improve patient management, the structure of cardiac disease management was improved, guideline-recommended care was supported, new ambulatory medical services and a morbidity-adapted reimbursement system were set up. Our aim was to determine the effects of this programme on the mortality and hospitalisation of enrolled patients with cardiac disorders. We conducted a comparative observational study in 2015 and 2016, based on insurance claims data. Overall, 13,404 enrolled patients with chronic heart failure (CHF) and 19,537 with coronary artery disease (CAD) were compared, respectively, to 8,776 and 16,696 patients that were receiving usual ambulatory cardiology care. Compared to the control group, patients enrolled in the programme had lower mortality (Hazard Ratio: 0.84; 95% CI: 0.77–0.91) and fewer all-cause hospitalisations (Rate Ratio: 0.94; 95% CI: 0.90–0.97). CHF-related hospitalisations in patients with CHF were also reduced (Rate Ratio: 0.76; 95% CI: 0.69–0.84). CAD patients showed a similar reduction in mortality rates (Hazard Ratio: 0.81; 95% CI: 0.76–0.88) and all-cause hospitalisation (Rate Ratio: 0.94; 95% CI: 0.91–0.97), but there was no effect on CAD-related hospitalisation. We conclude that intensified ambulatory care reduced mortality and hospitalisation in cardiology patients.

Highlights

Since 2010, an intensified ambulatory cardiology care programme has been implemented in southern Germany
Care coordination has been shown to optimise disease management, and improve patient o utcomes[6,7], notably in ambulatory care-sensitive conditions such as heart failure (CHF)[8] and coronary artery disease (CAD)[9], it is a major challenge to improve it within the framework of modern health s ystems[7]
Communication between general practitioners (GPs) and cardiologists participating in the programme is standardised and requires the mutual exchange of important clinical information

Summary

Introduction

Since 2010, an intensified ambulatory cardiology care programme has been implemented in southern Germany. Components of the cardiology care programme Structured disease management Promotion of guideline-recommended care New ambulatory medical services e.g., electrical cardioversion, specially trained healthcare assistants Morbidity-adapted reimbursement Incentives for repeat consultations in critical clinical situations and evidence-based pharmacotherapy Adherence to quality requirements e.g. in diagnostics, a minimum of 100 echocardiograms must be carried out per quarter Continuous data-driven quality improvement Participation in clinical peer group training sessions e.g. in drug therapy Coordinated care pathways with standardised communication between general practitioners and cardiologists Patient education and emphasis on nationwide disease management programmes Appointments for regular referrals within two weeks, and urgent referrals the same day. The objective of this study was to assess the effect of this cardiology care programme on mortality and hospitalisation in enrolled patients with heart failure and coronary artery disease

Objectives

Methods

Results

Conclusion