Mortality reduction benefits of a comprehensive cardiac care program for patients with occlusive coronary artery disease.
OBJECTIVE
To determine the effect of early and sustained enrollment in a comprehensive cardiac care (CCC) program on all-cause mortality in patients with coronary artery disease (CAD).


METHODS
Retrospective, longitudinal cohort study.


METHODS
Kaiser Permanente Colorado tracking database.


METHODS
A total of 4896 patients with an incident occlusive CAD event (index event), defined as acute myocardial infarction and/or percutaneous coronary intervention with or without stent placement, between January 1, 1996 and June 30, 2004.


RESULTS
All patients were categorized into one of four cohorts by time to enrollment into the CCC program relative to the index event: early CCC-enrolled less than 90 days after the index event (1630 patients), delayed CCC--enrolled 90 days or more after the index event (1211 patients), intermittent CCC--enrolled intermittently with noncontinuous care (483 patients), and no CCC--never enrolled (1572 patients). The primary outcome was all-cause mortality. Patients were censored at death from all causes, end of health plan membership, or study end (December 31, 2005), whichever came first. Patients with any exposure to the CCC were less likely to die compared with the no CCC cohort (p<0.001). After adjusting for baseline covariates, the early, delayed, and intermittent CCC cohorts had reduced hazard rate ratios for all-cause mortality of 0.11 (95% confidence interval [CI] 0.08-0.14), 0.35 (95% CI 0.29-0.44), and 0.54 (95% CI 0.41-0.70), respectively, compared with the no CCC cohort (all p<0.001).


CONCLUSIONS
Compared with those not enrolled in the CCC program, patients enrolled in the early CCC were 89% less likely to die. The earlier the program is started after a coronary event, the better the mortality reduction benefit.
Merenich
John A
JA
Department of Endocrinology, Colorado Permanente Medical Group, Denver, Colorado, USA. john.a.merenich@kp.org
Olson
Kari L
KL
Delate
Thomas
T
Rasmussen
Jon
J
Helling
Dennis K
DK
Ward
David G
DG
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D001794:Blood Pressure / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood; D003120:Colorado; D003191:Comprehensive Health Care / Q000379:methods* / Q000458:organization & administration; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010361:Patients / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D015607:Stents; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D008078:Cholesterol, LDL