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Journal of Cardiopulmonary Rehabilitation & Prevention:
doi: 10.1097/01.HCR.0000320068.35728.12
Cardiac Rehabilitation

Long‐Term Disease Management of Patients With Coronary Disease by Cardiac Rehabilitation Program Staff

Squires, Ray W. PhD; Montero-Gomez, Aura MD; Allison, Thomas G. PhD, MPH; Thomas, Randal J. MD

Continued Education
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Abstract

PURPOSE: 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%, β-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.

© 2008 Lippincott Williams & Wilkins, Inc.

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