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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

Journal of Cardiopulmonary Rehabilitation & Prevention: May/June 2008 - Volume 28 - Issue 3 - p 180–186
doi: 10.1097/01.HCR.0000320068.35728.12
Cardiac Rehabilitation

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.

We determined feasibility and benefits of a 3-year disease management program administered by cardiac rehabilitation (CR) staff in routine clinical practice. Results indicated that disease management in routine clinical practice by CR program staff is feasible and effective. We advocate expansion of CR into long-term disease management programs.

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Allison, and Thomas), and Postgrado de Cardiologia, Universidad del Zulia, Hospital del Sur “Dr. Pedro Irturbe”, Maracaibo, Venezuela (Dr Montero-Gomez).

Corresponding Author: Ray W. Squires, PhD, Mayo Clinic, Division of Cardiovascular Diseases and Internal Medicine, Gonda 5-318, 200 First St SW, Rochester, MN 55905 (squires.ray@mayo.edu).

© 2008 Lippincott Williams & Wilkins, Inc.