Author's response to reviews Title: Effects of a nurse-based case management compared to usual care among aged patients with myocardial infarction: Results from the randomized controlled KORINNA Study Authors:

1. In the abstract it is written that after randomization 11 patients were retrospectively excluded, but it is not clear why. Later on it is explained, but I find it rather confusing in the abstract. It is than more informative to describe if a per-protocol or intention-to-treat analysis has been conducted in the abstract. Ø Thank you very much for this comment! We have deleted the phrase regarding the retrospective exclusion in the abstract and have included the following sentence: “Statistical analysis was based on the intention-to-treat approach and included Cox Proportional Hazards models.” 2. Was readmission defined as a subsequent hospitalization to the same hospital, or did it include other hospitals as well? Ø Readmission includes other hospitals as well. You are absolutely right, that this information is missing and should be provided for the reader. In order to specify this information, we have included the following sentences: “Readmission was defined as admission to any hospital after discharge from the index hospital. Only hospital stays with duration of at least for 24 hours were included.“ 3. Did the authors also used a certain timeframe to readmission? Very often 30-days is applied, because of the reimbursement problems, especially in the US Ø We have not applied any timeframe. We hope that the specification of the readmission definition described above will clarify this. Background 1. The background is pretty staccato. Some more information on secondary prevention could be used, as the target audience of BMC geriatrics is more into geriatrics than cardiovascular care. It would give more sense to what a nurse-led casemanagement program could comprise. Ø We appreciate your idea to expand the background information. We have added the following information on secondary prevention measures and their use in Germany: “Guidelines for secondary prevention suggest lifestyle changes such as smoking cessation, increase of physical activity, weight management, risk factor control including blood pressure control, lipid and diabetes management, and pharmacological treatment for all persons with CHD (8). There is increasing evidence that elderly men and women with CHD also benefit from secondary prevention measures (9). However, elderly persons are more likely to have specific characteristics which may complicate the implementation of secondary prevention measures, e.g. the adherence to prescribed medication, such as reduced social support, multimorbidity, functional or cognitive impairments. Secondary prevention after hospital discharge in Germany is provided by a number of actors within the health care system, specifically by general health practitioners and cardiologists. Around 50% of the German patients with an AMI receive an inhospital cardiac rehabilitation over a period of 3 weeks in a specialized rehabilitation hospital. However, data suggest that patients aged above 60 receive in-hospital cardiac rehabilitation less often than younger persons (10). Moreover, in Germany no home-based early post-discharge programmes are available as compared to other countries (11). Long-term disease-management programs for patients with CHD are offered by health insurance companies. “ 2. I miss information on the current readmission rates in this specific group of older patients and am pretty sure that at least the systematic review of Pvru Bettger in Annals of Internal medicine 2012 on transitional care did display incidence rates in older people after myocardial infarction. Ø We have included information of readmission rates in the introduction section: “Patients with myocardial infarction who were discharged alive still are at risk for postdischarge hospital readmission. Rates for readmission within 30 days considerably vary among countries with highest rates observed in the United States (39.1%) and 3.5% reported from Germany (4). Older age was found to be a significant predictor of early readmission (5) and a 1-year readmission rate of 38% in patients > 65 years was reported by Andres et al. (6)” Method 1. The beginning of the method is not very structured. Labelling it with subheadings according to the consort checklist would help me as a reader to understand it better. Ø Thank you very much for this comment! We have now realized that the entire manuscript should be structured according to the CONSORT statement. Thus, we have included the following subheadings in the methods section: • Trial design and participants • Interventions • Outcomes • Sample size • Randomization • Statistical methods 2. When did the researchers include patients, were these consecutive patients that were admitted to the hospital, or did they only include on weekdays? Although it might be reported in the protocol, this is essential information for the trial report Ø We agree with you, that this information is missing in our manuscript. We have added the following sentence to the paragraph “Trial design and participants”: “Patients aged 65 and older who were hospitalized with a first or recurrent myocardial infarction between September 2008 and May 2010 in the Hospital of Augsburg, a tertiary care unit situated in the city of Augsburg, Southern Germany, were included consecutively.” 3. What is the definition of casemanagement program to the authors. As I read the intervention program, I would classify it more as a diseasemanagement program, as it is very much focused on cardiovascular care and risk management. Adding this to the article would make it more clear. The authors report that they assessed the GDS and functioning, but it seems like these are only measurements, and are not incorporated in the care Ø Thank you very much for this helpful comment! We agree with you that the intervention is not a pure case-management program but also includes elements from disease management. We have rewritten the entire paragraph describing the intervention: