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A case-management program of medium intensity does not improve cardiovascular risk factor control in coronary artery

A Nordmann1, I Heilmbauer, T Walker

  • 1Medical Outpatient Division, Department of Internal Medicine, University Hospital, Basel, Switzerland.

The American Journal of Medicine
|May 10, 2001
PubMed

Insights

A medium-intensity case-management program for coronary artery disease did not significantly improve overall cardiovascular risk factors. However, it did lead to better cholesterol control at 18 months in patients after acute coronary events.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Health Services Research

Background:

  • Intensive case-management programs can reduce cardiovascular risk factors in coronary artery disease (CAD) secondary prevention.
  • Less intensive approaches have not consistently demonstrated benefits.
  • This study investigates a medium-intensity case-management program for CAD patients.

Purpose of the Study:

  • To evaluate the effectiveness of a medium-intensity case-management program on cardiovascular risk factor control.
  • To assess improvements in lipid values, blood pressure, glucose, BMI, and smoking cessation.
  • To determine if this program offers a viable alternative to resource-intensive interventions.

Main Methods:

  • A randomized trial involving 201 patients hospitalized for acute coronary events.
  • Cluster randomization based on primary care physicians.
  • Intervention group received 1-hour clinician counseling plus 3- and 6-month reminders; control group received usual care.

Main Results:

  • No significant differences in lipid values, blood pressure, fasting blood glucose, BMI, or smoking rates at 9 or 18 months.
  • A significantly higher proportion of patients in the intervention group achieved target cholesterol values at 18 months (48% vs. 27%, P=0.002).
  • This cholesterol improvement was not observed at the 9-month follow-up.

Conclusions:

  • A hospital-based, clinician-counseling-focused case-management program did not substantially improve overall cardiovascular risk factor control.
  • The program showed a potential benefit in achieving target cholesterol levels at 18 months post-discharge.
  • Further research may be needed to optimize case-management intensity and components for CAD secondary prevention.
Abstract

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