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Outcomes of patients discharged from pharmacy-managed cardiovascular disease management

Kari L Olson1, Thomas Delate, Jon Rasmussen

  • 1Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO 80011, USA. kari.olson@kp.org

The American Journal of Managed Care
|August 13, 2009
PubMed

Insights

Patients with coronary artery disease (CAD) maintained lipid goals after leaving a cardiac risk service. An electronic reminder system showed similar effectiveness to usual care in managing low-density lipoprotein cholesterol (LDL-C).

Area of Science:

  • Cardiology
  • Clinical Pharmacy
  • Health Informatics

Background:

  • Patients with coronary artery disease (CAD) require ongoing management to maintain lipid goals.
  • Discharge from specialized cardiac programs may pose a risk for suboptimal lipid control.
  • Electronic laboratory reminder systems offer a potential tool for sustained patient care.

Purpose of the Study:

  • To assess if patients with CAD, after discharge from a Clinical Pharmacy Cardiac Risk Service (CPCRS), could maintain their lipid goals.
  • To evaluate the effectiveness of an electronic laboratory reminder system in sustaining lipid control compared to usual care.

Main Methods:

  • A 2-year randomized study involving 421 patients with prior CAD.
  • Patients meeting specific LDL-C and blood pressure goals were randomized to either continued CPCRS care or usual primary care with reminder letters.
  • Primary outcome: maintenance of low-density lipoprotein cholesterol (LDL-C) goal at study end; statistical analysis using t-tests and chi-squared tests.

Main Results:

  • No significant difference in maintaining LDL-C goal (<100 mg/dL) between CPCRS care (91%) and usual care (93.1%).
  • A trend towards better maintenance of a stricter LDL-C goal (<70 mg/dL) was observed in the CPCRS care group (68.6%) versus usual care (56.8%), though not statistically significant (P = .23).
  • The study involved patients with a mean age of 72 years, 74% male, with 1.7 years of follow-up.

Conclusions:

  • Most patients with coronary artery disease can maintain controlled LDL-C levels after discharge from a specialized cardiac disease management program.
  • An electronic laboratory reminder system appears to be a viable alternative to specialized care for sustaining lipid control in this population.
Abstract

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