Sustained long-term benefits of structured primary care for patients with coronary artery disease: a 12-year cohort study in Germany (2011–2022)

Abstract In 2022, cardiovascular diseases accounted for 32.7% of all deaths in the EU, with associated costs of €282 billion annually. In Germany, coronary artery disease (CAD) remains the leading cause of mortality and recent reductions in life expectancy gains have been attributed to excess CVD mortality. High rates of avoidable hospital admissions suggest shortcomings in ambulatory care. In 2004, Germany introduced the general practitioner-centred care (‘Hausarztzentrierte Versorgung” (HZV)) programme with the aim of strengthening primary care. This longitudinal observational cohort ( N = 125,758 in 2011, N = 169,101 in 2022) study based on German claims data describes the long-term effects of HZV on healthcare utilization and all-cause mortality for patients with CAD in observation period 2011–22. HZV participants had consistently lower odds of all-cause hospitalisation (OR 0.988, 95%CI, p < 0.001), CVD hospitalisation (OR 0.989, 95% CI, p < 0,001) and ambulatory care sensitive condition hospitalisation (OR 0.989, 95% CI, p < 0,001) in comparison to usual care. All-cause mortality reduced over the observation period and odds were significantly lower in the HZV group at the end of 2022 (OR 0.987, 95% CI, p < 0.001). These findings emphasise the role of structured, coordinated primary care in strengthening care for patients with CAD and support the broader implementation of GP-centred care models.