Effects of a 3-Year Nurse-Based Case Management in Aged Patients with Acute Myocardial Infarction on Rehospitalisation, Mortality, Risk Factors, Physical Functioning and Mental Health. A Secondary Analysis of the Randomized Controlled KORINNA Study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Home-based secondary prevention programs led by nurses have been proposed to facilitate patients’ adjustment to acute myocardial infarction (AMI). The objective of this study was to conduct secondary analyses of the three-year follow-up of a nurse-based case management for elderly patients discharged from hospital after an AMI.

Methods

In a single-centre randomized two-armed parallel group trial of hospitalized patients with AMI ≥65 years, patients hospitalized between September 2008 and May 2010 in the Hospital of Augsburg, Germany, were randomly assigned to case management or usual care. The case-management intervention consisted of a nurse-based follow-up for three years including home visits and telephone calls. Study endpoints were time to first unplanned readmission or death, clinical parameters, functional status, depressive symptoms and malnutrition risk. Persons who assessed three-year outcomes and validated readmission data were blinded. The intention-to-treat approach was applied to the statistical analyses which included Cox Proportional Hazards models.

Results

Three hundred forty patients were allocated to receive case-management (n = 168) or usual care (n = 172). During three years, in the intervention group there were 80 first unplanned readmissions and 6 deaths, while the control group had 111first unplanned readmissions and 3 deaths. The intervention did not significantly affect time to first unplanned readmission or death (Hazard Ratio 0.89, 95% confidence interval (CI) 0.67–1.19; p = 0.439), blood pressure, cholesterol level, instrumental activities of daily life (IADL) (only for men), and depressive symptoms. However, patients in the intervention group had a significantly better functional status, as assessed by the HAQ Disability Index, IADL (only for women), and hand grip strength, and better SCREEN-II malnutrition risk scores than patients in the control group.

Conclusions

A nurse-based management among elderly patients with AMI did not significantly affect time to unplanned readmissions or death during a three-year follow-up. However, the results indicate that functional status and malnutrition risk can be improved.

Trial registration

Current Controlled Trials ISRCTN02893746

Related collections

Most cited references 19

Record: found
Abstract: found
Article: not found

The Stanford Health Assessment Questionnaire: Dimensions and Practical Applications

Bonnie Bruce, James F. Fries (2003)

The ability to effectively measure health-related quality-of-life longitudinally is central to describing the impacts of disease, treatment, or other insults, including normal aging, upon the patient. Over the last two decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements, such as erythrocyte sedimentation rate, lipid profiles, or radiographs, to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on generic, patient-centered dimensions. The HAQ was designed to represent a model of patient-oriented outcome assessment and has played a major role in many diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of NSAID gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. Evidenced by its use over the past two decades in diverse settings, the HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It is available in more than 60 languages and is supported by a bibliography of more than 500 references. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. In this article, information regarding the HAQ's development, content, dissemination and reference sources for its uses, translations, and validations are provided.

0 comments Cited 177 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial.

M. D. Naylor, D Brooten, R. Campbell … (1999)

Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients, but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied. To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions. Randomized clinical trial with follow-up at 2, 6, 12, and 24 weeks after index hospital discharge. Two urban, academically affiliated hospitals in Philadelphia, Pa. Eligible patients were 65 years or older, hospitalized between August 1992 and March 1996, and had 1 of several medical and surgical reasons for admission. Intervention group patients received a comprehensive discharge planning and home follow-up protocol designed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses. Readmissions, time to first readmission, acute care visits after discharge, costs, functional status, depression, and patient satisfaction. A total of 363 patients (186 in the control group and 177 in the intervention group) were enrolled in the study; 70% of intervention and 74% of control subjects completed the trial. Mean age of sample was 75 years; 50% were men and 45% were black. By week 24 after the index hospital discharge, control group patients were more likely than intervention group patients to be readmitted at least once (37.1 % vs 20.3 %; P<.001). Fewer intervention group patients had multiple readmissions (6.2% vs 14.5%; P = .01) and the intervention group had fewer hospital days per patient (1.53 vs 4.09 days; P<.001). Time to first readmission was increased in the intervention group (P<.001). At 24 weeks after discharge, total Medicare reimbursements for health services were about $1.2 million in the control group vs about $0.6 million in the intervention group (P<.001). There were no significant group differences in post-discharge acute care visits, functional status, depression, or patient satisfaction. An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions, lengthened the time between discharge and readmission, and decreased the costs of providing health care. Thus, the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs.

0 comments Cited 165 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Estimating minimal clinically important differences of upper-extremity measures early after stroke.

Rebecca L Birkenmeier, Dorothy F. Edwards, Catherine E. Lang … (2008)

To estimate minimal clinically important difference (MCID) values of several upper-extremity measures early after stroke. Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial, an acute, single-blind randomized controlled trial of constraint-induced movement therapy. Subjects were tested at the prerandomization baseline assessment (average days poststroke, 9.5d) and the first posttreatment assessment (average days poststroke, 25.9d). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests. Inpatient rehabilitation hospital. Fifty-two people with hemiparesis poststroke. Not applicable. Estimated MCID values for grip strength, composite upper-extremity strength, Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and duration of upper-extremity use as measured with accelerometry. MCID values for grip strength were 5.0 and 6.2 kg for the affected dominant and nondominant sides, respectively. MCID values for the ARAT were 12 and 17 points, for the WMFT function score were 1.0 and 1.2 points, and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides, respectively. MCID values were indeterminate for the dominant (composite strength), the nondominant (WMFT time score), and both affected sides (duration of use) for the other measures. Our data provide some of the first estimates of MCID values for upper-extremity standardized measures early after stroke. Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke.

0 comments Cited 121 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Brett Thombs: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 26 March 2015

Publication date Collection: 2015

Volume: 10

Issue: 3

Electronic Location Identifier: e0116693

Affiliations

[1 ]Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

[2 ]KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany

[3 ]Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

[4 ]Department of Internal Medicine I—Cardiology, Central Hospital of Augsburg, Augsburg, Germany

[5 ]Department for Internal Medicine/Cardiology, Donau-Ries-Kliniken, Nördlingen, Germany

McGill University, CANADA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: CM BK RH. Performed the experiments: IK HS KB CM. Analyzed the data: BS MH. Wrote the paper: IK.

* E-mail: Inge.Kirchberger@ 123456helmholtz-muenchen.de

Article

Publisher ID: PONE-D-14-26778

DOI: 10.1371/journal.pone.0116693

PMC ID: 4374800

PubMed ID: 25811486

SO-VID: ad004477-3332-4076-a767-23f7984e5e48

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 23 June 2014

Date accepted : 11 December 2014

Page count

Figures: 3, Tables: 4, Pages: 17

Funding

This research was supported by the German Federal Ministry of Education and Research, http://www.bmbf.de/, Grant Number FKZ 01 ET 0713. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Due to restrictions from Helmholtz Zentrum München, data are available upon request for any researcher based on a standard agreement on data provision within the KORA Research Platform. Requests may be sent to Holf Rolle holle@ 123456helmholtz-muenchen.de .

Effects of a 3-Year Nurse-Based Case Management in Aged Patients with Acute Myocardial Infarction on Rehospitalisation, Mortality, Risk Factors, Physical Functioning and Mental Health. A Secondary Analysis of the Randomized Controlled KORINNA Study

Read this article at

Abstract

Background

Methods

Results

Conclusions

Trial registration

Related collections

PLOS Climate

Most cited references 19

The Stanford Health Assessment Questionnaire: Dimensions and Practical Applications

Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial.

Estimating minimal clinically important differences of upper-extremity measures early after stroke.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 100

Cited by 7

Most referenced authors 406