title: Reversing social disadvantage in secondary prevention of coronary heart disease.
abstract: BACKGROUND
  To compare and contrast the coronary heart disease (CHD) risk factors of lower socio-economic status public hospital patients with those of privately insured CHD patients before and after six months of telephone delivered coaching using The COACH Program.
  
  
  METHODS
  A retrospective observational study which contrasts the lifestyle and biomedical coronary risk factor status of 2256 public hospital patients with the same risk factors of 3278 patients who had private health insurance. All patients received an average of 5 coach sessions over 6 months.
  
  
  RESULTS
  The public hospital patients were four years younger and had multiple measures confirming their lower socio-economic status than their private hospital counterparts. At entry to the program, the public hospital patients had worse risk factor levels than the privately insured patients for total and LDL-cholesterol, triglycerides, fasting glucose, smoking and physical activity levels (P<0.0001) but better status for systolic and diastolic blood pressures and alcohol intake. At exit from the program, many of these differences had diminished or disappeared. The public hospital patients had greater improvements in their risk factor status for total and LDL-cholesterol, fasting glucose, body weight, smoking status and physical activity level than did the privately insured patients (P<0.05).
  
  
  CONCLUSIONS
  This paper demonstrates that a program of initiating contact with patients with CHD, identifying treatment gaps in their management and coaching to achieve guideline recommended risk factor targets can help reduce health inequalities in such patients and thus benefit all patients in the context of ongoing secondary prevention.
authors.affiliation: St Vincent's Hospital, Melbourne, Australia; The University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia; Cardiovascular Research Centre, Australian Catholic University, East Melbourne, Australia. Electronic address: michael.jelinek@svhm.org.au.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Jelinek
authors.affiliation: St Vincent's Hospital, Melbourne, Australia; The University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: Santamaria
authors.affiliation: St Vincent's Hospital, Melbourne, Australia; The University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
authors.forename: James D
authors.initials: JD
authors.lastname: Best
authors.affiliation: Cardiovascular Research Centre, Australian Catholic University, East Melbourne, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tonkin
authors.affiliation: The University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Margarite J
authors.initials: MJ
authors.lastname: Vale
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods*; D035862:Vulnerable Populations
keywords: Coronary disease; Rehabilitation; Risk factors; Secondary prevention; Telephone