Outcomes of patients discharged from pharmacy-managed cardiovascular disease management.
OBJECTIVE
To evaluate whether patients with coronary artery disease (CAD) discharged from the Clinical Pharmacy Cardiac Risk Service (CPCRS) would maintain their lipid goals with use of an electronic laboratory reminder system.


METHODS
A 2-year, randomized study at Kaiser Permanente Colorado.


METHODS
Patients with prior CAD (acute myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention) who had been enrolled in the CPCRS for at least 1 year and who had 2 consecutive low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol, and blood pressure readings at goal within 6 months before enrollment were randomized to remain in the CPCRS (CPCRS care) or to receive usual care from primary care physicians plus laboratory reminder letters (usual care). The primary outcome was maintenance of LDL-C goal at study end. The t test and chi(2) test of association were used to assess differences in mean and categorical values, respectively.


RESULTS
A total of 421 patients (214 CPCRS care, 207 usual care) were randomized. Their mean age was 72 years; 74% were male. After 1.7 years of follow-up, the proportions of patients maintaining their LDL-C goal of <100 mg/dL were 91% and 93.1% in the CPCRS care and usual care groups, respectively (P = .46). The proportions maintaining their LDL-C goal of <70 mg/dL were 68.6% and 56.8% in the CPCRS care and usual care groups, respectively (P = .23).


CONCLUSIONS
This study demonstrated that LDL-C measures can remain controlled in most patients discharged from a cardiac disease management program.
Olson
Kari L
KL
Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO 80011, USA. kari.olson@kp.org
Delate
Thomas
T
Rasmussen
Jon
J
Humphries
Tammy L
TL
Merenich
John A
JA
D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D003120:Colorado; D003324:Coronary Artery Disease / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D054539:Medication Therapy Management; D010349:Patient Compliance; D010351:Patient Discharge; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000458:organization & administration; D017010:Reminder Systems; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors