title: Effect of a comprehensive ambulatory care model on outcomes of patients with acute coronary syndrome in Colombia.
abstract: OBJECTIVE
  To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome.
  
  
  METHODS
  Participants in this quasi-experimental intervention study included acute coronary syndrome patients 30-70 years old. The intervention group (n = 165) received care under the CACM, guided by an interdisciplinary team. The CACM included transitional care, risk stratification by severity, physiological profiling (impedance cardiography), and a treatment plan in accordance with current guidelines. The control group (n = 277) received conventional, recommended care in an ambulatory cardiac rehabilitation program. During one year of follow-up, the use of emergency and hospital services related to new cardiovascular and coronary events was evaluated.
  
  
  RESULTS
  Differences in the numbers of cardiovascular events (P = 0.003) and coronary events (P = 0.006) experienced by patients were found between the control group and the intervention group. The instantaneous risk of a cardiovascular event (hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.17-2.75; P = 0.007) and of a coronary event (HR = 1.81; 95% CI: 1.13-2.90; P = 0.013), after adjusting for age, sex, smoking, and compromised coronary arteries, was higher in the control group than the intervention group.
  
  
  CONCLUSIONS
  Provision of care under the CACM to patients who had experienced an acute coronary event reduced emergency room visits and rehospitalizations related to new cardiovascular and coronary events by 40%. The average "number needed to treat" (NNT) under the CACM to have an impact on one person (in this case, the prevention of one cardiovascular or coronary event), was 9 and 11 respectively, indicating it is cost-effective.
authors.affiliation: Centro Clínico y de Investigación, Soluciones Integrales en Riesgo Cardiovascular, Medellín, Colombia, dagnovar@une.net.co.
authors.forename: Dagnovar
authors.initials: D
authors.lastname: Aristizábal
authors.affiliation: School of Medicine, Universidad de Antioquia, Medellín, Colombia.
authors.forename: Jaime
authors.initials: J
authors.lastname: Gallo
authors.affiliation: Centro Clínico y de Investigación, Soluciones Integrales en Riesgo Cardiovascular, Medellín, Colombia, dagnovar@une.net.co.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Valencia
authors.affiliation: Centro Clínico y de Investigación, Soluciones Integrales en Riesgo Cardiovascular, Medellín, Colombia, dagnovar@une.net.co.
authors.forename: Juan
authors.initials: J
authors.lastname: Jaime
authors.affiliation: Centro Clínico y de Investigación, Soluciones Integrales en Riesgo Cardiovascular, Medellín, Colombia, dagnovar@une.net.co.
authors.forename: Mónica
authors.initials: M
authors.lastname: Correa
authors.affiliation: Centro Clínico y de Investigación, Soluciones Integrales en Riesgo Cardiovascular, Medellín, Colombia, dagnovar@une.net.co.
authors.forename: Alberto
authors.initials: A
authors.lastname: Aristizábal
authors.affiliation: EPS SURA, Medellín, Colombia.
authors.forename: Marcela
authors.initials: M
authors.lastname: Montoya
authors.affiliation: Centro Clínico y de Investigación, Soluciones Integrales en Riesgo Cardiovascular, Medellín, Colombia, dagnovar@une.net.co.
authors.forename: José
authors.initials: J
authors.lastname: Abad
mesh_terms: D054058:Acute Coronary Syndrome; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003105:Colombia; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012907:Smoking