Long-term disease management of patients with coronary disease by cardiac rehabilitation program staff.
OBJECTIVE
Randomized-clinical trials have demonstrated the benefits of disease management for patients with coronary disease. It is not known if long-term disease management in routine clinical practice provided by cardiac rehabilitation (CR) program staff is possible. The goal of this study was to evaluate the feasibility and clinical benefits of a 3-year disease-management program in the setting of an outpatient CR facility.


METHODS
Consecutive patients (n = 503) referred to CR and who were available for long-term follow-up served as subjects. After a phase II CR program, disease managers assessed secondary-prevention goals every 3 to 6 months via face-to-face meetings with each patient. Outcome measures included use of cardioprotective medications, coronary risk factors, amount of habitual exercise training, and all-cause mortality.


RESULTS
At 3 years, aspirin usage was 91%, statin usage 91%, beta-blocker usage 78%, and angiotensin-converting enzyme inhibitor usage 76%. Low-density lipoprotein cholesterol was 90 +/- 23 mg/dL, systolic blood pressure was 126 +/- 19 mm Hg, and body mass index was 29.0 +/- 5.1 kg/m2. Exercise training averaged 139 +/- 123 minutes per week. Annual mortality was 1.9%. There were no differences (P > .05) in medication usage or low-density lipoprotein cholesterol for men versus women, or for age below 65 years versus age 65 years or greater.


CONCLUSIONS
Long-term disease management of patients with coronary disease in routine clinical practice by CR program staff is feasible and effective in achieving and maintaining secondary-prevention goals. Overweight remains a prevalent and persistent risk factor. We advocate expansion of CR programs into long-term coronary disease-management programs.
Squires
Ray W
RW
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. squires.ray@mayo.edu
Montero-Gomez
Aura
A
Allison
Thomas G
TG
Thomas
Randal J
RJ
D000368:Aged; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000517:prevention & control / Q000534:rehabilitation*; D019468:Disease Management; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome