The Effectiveness of the Cardiovascular Disease Prevention Programme ‘KardioPro’ Initiated by a German Sickness Fund: A Time-to-Event Analysis of Routine Data

• Published in: PloS one Vol. 9; no. 12; p. e114720
• Main Authors: Witt, Sabine, Leidl, Reiner, Becker, Christian, Holle, Rolf, Block, Michael, Brachmann, Johannes, Silber, Sigmund, Stollenwerk, Björn
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.12.2014; Public Library of Science (PLoS)
• Subjects: Cardiology; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cardiovascular Diseases - prevention & control; Case-Control Studies; Cerebral infarction; Confidence intervals; Data Interpretation, Statistical; Data processing; Disease prevention; Environmental health; Ethics; Failure analysis; Female; Hazards; Health care policy; Health economics; Health Personnel - standards; Heart attack; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Infarction; Insurance, Health; Ischemia; Male; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Morbidity; Mortality; Myocardial infarction; Prevention; Primary Prevention; Prognosis; Program Evaluation; Propensity Score; Reduction; Regression analysis; Retrospective Studies; Risk Factors; Risk reduction; Statistical analysis; Stroke; Studies; Survival analysis; Survival Rate; Systematic review; Time Factors; New York; United States > US; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0114720

Cardiovascular disease is the leading cause of morbidity and mortality in the developed world. To reduce this burden of disease, a German sickness fund ('Siemens-Betriebskrankenkasse', SBK) initiated the prevention programme 'KardioPro' including primary (risk factor reduction) and secondary (screening) prevention and guideline-based treatment. The aim of this study was to assess the effectiveness of 'KardioPro' as it is implemented in the real world. The study is based on sickness fund routine data. The control group was selected from non-participants via propensity score matching. Study analysis was based on time-to-event analysis via Cox proportional hazards regression with the endpoint 'all-cause mortality, acute myocardial infarction (MI) and ischemic stroke (1)', 'all-cause mortality (2)' and 'non-fatal acute MI and ischemic stroke (3)'. A total of 26,202 insurants were included, 13,101 participants and 13,101 control subjects. 'KardioPro' enrollment was associated with risk reductions of 23.5% (95% confidence interval (CI) 13.0-32.7%) (1), 41.7% (95% CI 30.2-51.2%) (2) and 3.5% (hazard ratio 0.965, 95% CI 0.811-1.148) (3). This corresponds to an absolute risk reduction of 0.29% (1), 0.31% (2) and 0.03% (3) per year. The prevention programme initiated by a German statutory sickness fund appears to be effective with regard to all-cause mortality. The non-significant reduction in non-fatal events might result from a shift from fatal to non-fatal events.