%0 Journal Article
%T Evaluation of medical and health economic effectiveness of non-pharmacological secondary prevention of coronary heart disease
%A M¨ıller-Riemenschneider
%A Falk
%A Damm
%A Kathrin
%A Meinhard
%A Charlotte
%A Bockelbrink
%A Angelina
%J GMS Health Technology Assessment
%D 2009
%I German Medical Science, D¨ısseldorf
%X Background: Coronary heart disease (CHD) is a common and potentially fatal malady with a life time prevalence of over 20%. For Germany, the mortality attributable to chronic ischemic heart disease or acute myocardial infarction is estimated at 140,000 deaths per year. An association between prognosis of CHD and lifestyle risk factors has been consistently shown. To positively influence lifestyle risk factors in patients with CHD, non-pharmaceutical secondary prevention strategies are frequently recommended and implemented. Objectives: The aim of this HTA (HTA = Health Technology Assessment) is to summarise the current literature on strategies for non-pharmaceutical secondary prevention in patients with CHD and to evaluate their medical effectiveness/efficacy and cost-effectiveness as well as the ethical, social and legal implications. In addition, this report aims to compare the effectiveness and efficacy of different intervention components and to evaluate the generalisability with regard to the German context. Methods: Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition, a manual search of identified reference lists was conducted. The present report includes German and English literature published between January 2003 and September 2008 targeting adults with CHD. The methodological quality of included studies was assessed according to pre-defined quality criteria, based on the criteria of evidence based medicine. Results: Among 9,074 publications 43 medical publications met the inclusion criteria. Overall study quality is satisfactory, but only half the studies report overall mortality or cardiac mortality as an outcome, while the remaining studies report less reliable outcome parameters. The follow-up duration varies between twelve and 120 months. Although overall effectiveness of non-pharmaceutical secondary prevention programs shows considerable heterogeneity, there is evidence for the long-term effectiveness concerning mortality, recurrent cardiac events and quality of life. Interventions based on exercise and also multicomponent interventions report more conclusive evidence for reducing mortality, while interventions focusing on psychosocial risk factors seem to be more effective in improving quality of life. Only two studies from Germany fulfill the methodological criteria and are included in this report. Additionally, 25 economic publications met the inclusion criteria. Both, quantity and quality of publications deal
%K Coronary heart disease
%K secondary prevention
%K prevention
%K non-pharmacological
%K effectiveness
%K cost-effectiveness
%K efficiency
%K intervention
%K psychosocial
%K intervention
%K multimodal
%K exercise
%K training
%K reduction
%K stress
%K smoking cessation
%K dietary change
%K rehabilitation
%U http://www.egms.de/static/en/journals/hta/2009-5/hta000078.shtml