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Cardiovascular risk management with liaison critical path in Japan: its effects on implementation of evidence-based
Morihiro Matsuda1, Manami Akizuki, Orie Nishimoto
1Department of Cardiology, National Hospital Organization, Kure Medical Center, 3-1 Aoyama-cho, Kure, Hiroshima 737-0023, Japan.
Insights
Liaison critical paths (LCPs) improved follow-up care for coronary artery disease (CAD) patients, increasing hospital visits and medication adherence. LCPs also enhanced achievement of lipid targets, demonstrating their value in clinical practice.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Liaison critical paths (LCPs) were designed to improve collaborative care for coronary artery disease (CAD) patients between emergency hospital cardiologists and referring physicians.
- Sharing medical information, including cardioprotective medications and cardiovascular risk factors, is central to LCPs.
- The real-world effectiveness of LCPs in clinical practice remains largely unknown.
Purpose of the Study:
- To evaluate the impact of LCPs on the management of CAD patients after percutaneous coronary intervention.
- To assess the implementation rates of scheduled visits, cardioprotective medications, and risk factor measurements following LCP adoption.
Main Methods:
- An observational study was conducted on CAD patients who underwent percutaneous coronary intervention between September 2007 and June 2010.
- Patients were managed using LCPs by referring physicians post-discharge.
- Data on hospital visits, medication prescriptions, and risk factor measurements were collected at 6 and 12 months post-discharge.
Main Results:
- Implementation of scheduled hospital visits significantly increased from 50.7% to 89.3% after LCP implementation.
- At 12 months, prescription rates for anti-platelet drugs, statins, beta-blockers, and ACE inhibitors/ARBs were high (99.7%, 95.0%, 77.1%, 74.3% respectively).
- Significant improvements were observed in LDL-C and HDL-C target achievement rates (from 48.6% to 64.5% and 62.0% to 82.7% respectively). While BMI, blood pressure, triglycerides, and HbA1c targets were not significantly changed, patients adhering to all visits showed improvements in these parameters.
Conclusions:
- LCPs appear to facilitate the implementation of optimal medical therapy for CAD patients in clinical practice.
- LCPs contribute to improved achievement of cardiovascular risk factor targets.
- The study suggests LCPs are a valuable tool for enhancing collaborative care and patient outcomes in CAD management.
Background:
Liaison critical paths (LCPs) for coronary artery disease (CAD) were developed to support collaborative care for CAD patients between cardiologists in emergency hospitals and referring physicians through sharing of medical information, including cardioprotective medications and cardiovascular risk factors. However, little is known about the effects of LCPs in practice.
Methods:
We conducted an observational study of CAD patients undergoing percutaneous coronary intervention in our hospital between September 2007 and June 2010; these patients were managed with an LCP by referring physicians after discharge. We surveyed implementation of scheduled hospital visits, prescription of cardioprotective medicines, and risk factor measurements 6 and 12 months after discharge.
Results:
Implementation rate of hospital visits was significantly elevated from 50.7% to 89.3% after establishing LCPs. At the 12-month visit, prescription rates for anti-platelet drugs, statins, β-blockers, and angiotensin-converting enzyme inhibitors or angiotensin II type I receptor blockers were 99.7%, 95.0%, 77.1%, and 74.3%, respectively. Target achievement rates for low-density lipoprotein cholesterol (LDL-C; < 100 mg/dL) and high-density lipoprotein cholesterol (HDL-C; ≥ 40 mg/dL) significantly increased from 48.6% to 64.5% and 62.0% to 82.7%, respectively, while those for body mass index (BMI; < 25 kg/m(2)), blood pressure (< 130/80 mmHg), triglycerides (< 150 mg/dL), and HbA1c (< 7.0 %) were unchanged. BMI, triglycerides, HDL-C, LDL-C, and HbA1c levels significantly improved in patients who implemented all visits. Moreover, risk factor management did not differ significantly between cardiologists and non-cardiologists using LCPs.
Conclusions:
LCPs for CAD may facilitate implementation of optimal medical therapy and target achievement of risk factors in practice.
Keywords:
Liaison critical path; Coronary artery disease; Cardiovascular prevention; Risk factors; Clinical practice.
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